Single versus two-stage management of long-bone chronic osteomyelitis in adults: a systematic review and meta-analysis.

BACKGROUND: Chronic osteomyelitis is a debilitating bone infection, characterized by a persistent infection over months to years, poses diagnostic and therapeutic challenges due to its insidious nature and potential for severe bone and soft tissue destruction. This systematic review and meta-analysis aims to review the literature on the treatment of chronic osteomyelitis in long bones and assess cure rates in single versus two-stage surgery. METHODS: Following the PRISMA guidelines and registered with PROSPERO (ID: CRD42021231237), this review included studies that reported on the management of chronic osteomyelitis in long bones using either a planned one-stage or two-stage surgical approach in adult patients. Databases searched included Medline, Embase, Web of Science, CINAHL, HMIC, and AMED, using keywords related to osteomyelitis, long bones, and surgical management. Eligibility criteria focused on adults with chronic osteomyelitis in long bones, with outcomes reported after a minimum follow-up of 12 months. The meta-analysis utilized the random-effects model to pool cure rates. RESULTS: The analysis included 42 studies with a total of 1605 patients. The overall pooled cure rate was 91% (CI 95%) with no significant difference observed between single-stage and two-stage surgeries (X2 = 0.76, P > 0.05). Complications were reported in 26.6% of cases in single-stage procedures and 27.6% in two-stage procedures, with prolonged wound drainage noted as a common issue. Dead space management techniques varied across studies, with antibiotic-loaded calcium sulphate beads used in 30.4% of cases. CONCLUSION: This meta-analysis reveals no significant difference in cure rates between single and two-stage surgical treatments for chronic osteomyelitis in long bones, supporting the efficacy of both approaches. The current treatment strategy should include a combination of debridement, dead space management using local and systematic antibiotics and soft tissue reconstruction if necessary.

The National Hip Fracture Database is only as good as the data we feed it - significant inaccuracy demonstrated and how to improve it.

INTRODUCTION: The National Hip Fracture Database of England, Wales and Northern Ireland (NHFD) is the largest such database in the world. Data errors in within the NHFD lead to spurious evidence which ultimately informs Orthopaedic, Anaesthetic and Orthogeriatric clinical practice. MATERIALS AND METHODS: This multi-centre quality improvement study investigated, and sought to improve data inaccuracy within the NHFD. Hip arthroplasty episodes recorded between 2011-2020 were analysed for errors in operation, implant polarity and cementation. RESULTS: Inaccuracies were observed in 20.5% of 3972 data entries. Following the introduction of a hip fracture clinical data administrator in each centre, inaccuracies reduced four-fold (5.2% of 559 data entries). CONCLUSION: We advise caution when utilising NHFD data for research and audit purposes. In order to build a robust, accurate database for future research, we recommend the incorporation of specialist data administrators into the hip fracture multidisciplinary team.