An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique (version 2023) / 中华创伤杂志

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Management of pediatric acute hematogenous osteomyelitis / 中华创伤骨科杂志

Acute hematogenous osteomyelitis (AHO) is the type of its kind diagnosed most frequently in pediatric patients. In the past decade, the incidence of methicillin-resistant Staphylococcus aureus infections has increased in children. The more complex situation of infections may lead additionally to deep vein thrombosis (DVT), septic pulmonary embolism, pneumonia, empyema, endocarditis, bacteremia and septic shock. Hence, hospital stays are often lengthy and patients often critically ill. Since delayed appropriate therapy can lead to chronic osteomyelitis, as well as impairments in bone growth and development, early accurate diagnosis and prompt initiation of appropriate treatment remain central principles in the evaluation and treatment of AHO. Therefore, care of children with AHO inevitably requires an organized and interdisciplinary approach to reach timely, comprehensive and accurate diagnoses so that effective treatment may be carefully planned and enacted with subsequent monitoring of the child until clinical resolution is achieved. This review is devoted exclusively to the management of AHO in children, providing an update on the current understanding of existing evidence and future directions to improve care for pediatric AHO.

Proximal versus distal tibial bone transport in the treatment of chronic tibial osteomyelitis / 中华创伤骨科杂志

Objective:To compare the clinical effects on new bone formation and foot-ankle function between proximal tibial bone transport and distal tibial bone transport in the treatment of massive bone defects after tibial osteomyelitis debridement.Methods:From July 2012 to July 2017, 42 patients with chronic tibial osteomyelitis received bone transport surgery at Department of Orthopaedics, Nanfang Hospital.According to the Cierny-Mader classification for chronic osteomyelitis, all of them belonged to diffusive tibial osteomyelitis (type IV).Of them, 32 were treated by proximal tibial bone transport after tibial osteomyelitis debridement.In the proximal group, there were 27 males and 5 females, aged from 17 to 65 years and involving 20 left and 12 right sides. The other 10 cases received distal tibial bone transport. In the distal group, all of them were male, aged from 25 to 63 years and involving 6 left and 4 right sides. The 2 groups were compared in terms of external fixation index (EFI) and American Orthopaedic Foot & Ankle Society(AOFAS) Ankle and Hindfoot Scale.Results:There were no significant differences between the 2 groups in the preoperative general data such as gender, age or osteomyelitis site, indicating the 2 groups were comparable ( P>0.05). Both groups obtained complete follow-up. The proximal group was followed up for 590.1 d ± 287.3 d and the distal group for 615.6 d ± 130.6 d, showing no significant difference between groups ( P>0.05). In the proximal group 2 cases developed talipes equinovalgus after bone transport while in the distal group 3 cases did, and surgical intervention was needed for them. Surgical intervention was also carried out for16 cases of non-union at the docking site in the proximal group and for 2 ones in the distal group. The EFI was 76.2 d/cm±50.0 d/cm for the proximal group and 84.3 d/cm ± 59.9 d/cm for the distal group, showing no significant difference between groups ( P>0.05). The AOFAS scores were 81.4±10.1 for the proximal group and 60.0±5.9 for the distal group, showing a significant difference ( P<0.05). Conclusion:In the treatment of massive bone defects after tibial osteomyelitis debridement, no significant difference has been observed in the effect on bone formation between proximal tibial bone transport and distal tibial bone transport, but the former transport may have a less adverse effect on foot-ankle function.

The application of micro-dissected polyfoliate anterolateral thigh perforator flap in repair of complex wound in extremities / 中华显微外科杂志

Objective To investigate the design,incisional method and clinical experiences of using the mi cro-dissected polyfoliate anterolateral thigh perforator flap to repair of complex soft tissue defect in extremities.Methods From June,2017 to September,2018,12 cases of different kinds of complex soft tissue defect in extremities were repaired by micro-dissected free polyfoliate anterolateral thigh perforator flap.Each flap was divided into two cutaneous perforators to give two separate flap with a common vascular supply.The flaps were cut from the superficial layer of the deep cervical fesciae and without fascia lata.The donor sites were treated by subcutaneous cosmetic suture.Patients were followed-up by outpatient service,telephone and WeChat video to observe and record the flap's appearance,sensory recovery,extremities function and the scars of the donor site to evaluate its clinical efficacy.Results All flaps survived without vascular crisis happened except one-leaf necrosis occurred,which healed with local flap transferring.The donor sites remained linear scars.The mean flap thickness of this group after micro-dissection was (4.5±0.5) mm.All the patients were followed-up for 5-15 months.The 2 point discrimination ranged between 0.5-2.0 cm.Sensory restoration ranking was S3-S3+.The range of montion of wrist joint was 65°-90°,and that of ankle joint was 40°-60°.Conclusion The micro-dissected polyfoliate anterolateral thigh perforator flap is an ideal method for complex and irregular multiple sites soft tissue defect in extremities as it can keep good economic benefit and minimal damage to the donor site.

Preogress in diagnosis and treatment of diabetic foot osteomyelitis / 中华创伤骨科杂志

Diabetic foot ulcer is a major complication of diabetes which is the most expensive and the most difficult to deal with and leads to a high rate of non-traumatic amputation.Diabetic foot osteomyelitis results from aggravation of diabetic foot ulcer.Unfortunately,the current therapeutic outcomes of diabetic foot osteomyelitis are still unsatisfactory because of its difficult diagnosis and special treatment protocols which are entirely different from those for conventional soft tissue infections.This paper summarizes the latest advances achieved in diagnosis and treatment of diabetic foot osteomyelitis.

Association between tumor necrosis factor-α and lymphotoxin α gene polymorphisms and susceptibility to extremity post-traumatic osteomyelitis in Chinese population / 中华创伤骨科杂志

Objective To investigate the association between tumor necrosis factor-α(TNF-α)and lymphotoxin α(LTα) gene single nucleotide polymorphisms (SNPs) and susceptibility to extremity post-traumatic osteomyelitis in Chinese population.Methods We used SNaPshot genotyping method to detect genotypes of 6 TNF-α gene SNP sites (rs1799964,rs1800630,rs1799724,rs1800750,rs1800629 and rs361525) and 1 LT α gene SNP site of rs909253 in 189 patients with post-traunatic osteomyelitis and 200 healthy controls.Genetic models were applied to investigate the potential links between the above-mentioned SNPs and risks of developing post-traumatic osteomyelitis.Results Outcomes revealed that the frequency of mutant allele C of rs909253 in the patient group was statistically higher than that in healthy controls (54.23％ versus 45.00％,P =0.010,OR =1.448,95％ CI 1.092 ～ 1.921).Significant correlations were found between rs909253 and risk of developing post-traumatic osteomyelitis by recessive model (CC versus CT+TT,P=0.012,OR=1.868,95％CI1.150～3.035) and homozygote model (CCversusTT,P=0.021,OR=2.016,95％ CI 1.111～3.658).The frequency of CC (29.63％) in the patient group was higher than that in the control group (17.50％).With regard to rs1800629 site of TNF-oα gene,we only found that the frequency of mutant allele A (4.23％) in the patient group was statistically lower than that(7.75％) in the control group (P=0.040,OR=0.526,95％ CI 0.283 ～0.978).Conclusions LTαgeneSNP site rs909253 may be linked with elevated risk of developing post-traumatic osteomyelitis in Chinese population.Mutant allele C may be a risk factor and people with genotype of CC may be a group at a higher risk of developing post-traumatic osteomyelitis in China.