A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis: a retrospective comparative study.

The treatment of chronic osteomyelitis often includes surgical debridement and filling the resultant void with antibiotic-loaded polymethylmethacrylate cement, bone grafts or bone substitutes. Recently, the use of bioactive glass to treat bone defects in infections has been reported in a limited series of patients. However, no direct comparison between this biomaterial and antibiotic-loaded bone substitute has been performed. In this retrospective study, we compared the safety and efficacy of surgical debridement and local application of the bioactive glass S53P4 in a series of 27 patients affected by chronic osteomyelitis of the long bones (Group A) with two other series, treated respectively with an antibiotic-loaded hydroxyapatite and calcium sulphate compound (Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded demineralised bone matrix (Group C; n = 22). Systemic antibiotics were also used in all groups. After comparable periods of follow-up, the control of infection was similar in the three groups. In particular, 25 out of 27 (92.6%) patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out of 22 (86.3%) in Group C showed no infection recurrence at means of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up, respectively, while Group A showed a reduced wound complication rate. Our results show that patients treated with a bioactive glass without local antibiotics achieved similar eradication of infection and less drainage than those treated with two different antibiotic-loaded calcium-based bone substitutes.

Italian guidelines for the diagnosis and infectious disease management of osteomyelitis and prosthetic joint infections in adults.

Bone and joint infections are recognized as difficult-to-treat infections that result in significant morbidity and mortality among patients and increased healthcare costs. This article presents the recommendations for the diagnosis and management of osteomyelitis and prosthetic joint infections in adults developed by Bone and Joint Infections Committee for the Italian Society of Infectious and Tropical Diseases. It contains data published through to November 2007. An evidence-based scoring system that is used by the Infectious Diseases Society of America was applied to treatment recommendations.

[Treatment of osteomyelitis by local antibiotics using a portable electronic micropump]. / Traitement de l'ostéomyélite par antibiothérapie locale utilisant une micropompe électronique portable.

INTRODUCTION: Systemic administration of antibiotics in osteoarticular infections is characterized by: 1) systemic side effects: 2) questionable penetration of the antibiotic into the infected and ischaemic areas: 3) mandatory hospitalization for prolonged administration of antibiotics. Aware of these difficulties, orthopedic surgeons have long been seeking an effective method of local antibiotic administration. The authors report their original experience with the use of an external, portable electronic micro pump for continuous local delivery of antibiotics in conjunction with surgical debridement, in the treatment of osteomyelitis. MATERIALS AND METHODS: Ten patients with active chronic osteomyelitis, were treated with surgical debridement and local antibiotic therapy. On the basis of the sensitivity disk findings, vancomycin or amikacin was delivered locally through an external portable, electronically programmable micro pump. To connect the pump with the infected site Groshong or Buchwald catheters were employed. The reservoir of the pump was refilled every 10-15 days. RESULTS: The duration of symptoms ranged from six months to fifteen years. All patients had undergone at least one previous unsuccessful treatment consisting of surgical debridement and/or prolonged intravenous antibiotic therapy. The duration of the infusion therapy ranged from 80 to 207 days (mean 109 +/- 37.7). At 33.7 +/- 5.6 months follow-up (range twenty-one to thirty-nine months) eight patients out of nine (one patient was lost to follow-up), showed no recurrence of the infection as manifested by clinical, laboratory and imaging data. Serum vancomycin and amikacin levels, measured at different intervals from the beginning of therapy, were always well below the recommended through levels for systemic infusion. There were no side effects linked to the prolonged administration of antibiotics, no technical complications connected with the implantation and removal of the catheter and no infections of inflammation of subcutaneous tissue where the catheter had been placed or of the skin around the catheter. DISCUSSION: The use of subcutaneous, totally implantable infusion drugs pumps, as proposed by Clayton, Perry and co-workers (1986) allows: 1) to maintain adequate local levels of a wide variety of antibiotics for a long period of time, avoiding systemic toxicity; 2) to stop the infusion in case of adverse reactions (allergic response): 3) to administer the treatment on an outpatient basis. Our original proposal of an externally portable micro pump adds the following advantages: 1) it is less invasive: 2) no risk of infection of the subcutaneous pocket where the pump is lodged: 3) better stability of the antibiotic, being at ambient temperature instead of at nearly 30 degrees C: 4) much lower cost, the external pump being less expensive than an implantable one and is reusable. CONCLUSION: Our experience shows: 1) the simplicity and limited invasiveness of this technique, which, without excluding other forms of therapy, allows to deliver antibiotics in the infected focus for months; 2) the absence of side effects and technical complications; 3) the good quality of life of the patients during the treatment; 4) the low cost for the health care system, since the patients are followed-up and the reservoirs refilled on an out-patient basis.

Fractures and pseudarthrosis of the carpal scaphoid.

The ultimate outcome of fractures of the scaphoid bone is determined by the choice of initial treatment. The special characteristics of the blood supply to the bone, which often increase the risk of non-union, have prompted us to propose the indications for primary surgical treatment based on the radiographic appearances. The authors propose a classification of the radiographic characteristics of fractures of the scaphoid for determining at the outset the treatment most likely to achieve consolidation and hence a more rapid resumption of occupational and sports activities. They present the results obtained in the treatment of 101 recent fractures of the scaphoid, eighty-one of which they were able to follow up after at least one year. In cases of established pseudarthrosis of the scaphoid they propose a pedicled transplant technique as conforming better to the anatomical, morphological and functional pre-requisites of the operation. The results obtained in the treatment of twenty-nine cases of pseudarthrosis are presented. The case material relates to patients treated at the G. Pini Orthopaedic Institute of Milan and, in the case of sportsmen, at the Centre for sports injuries of the same institute.

An apparatus for the radiographic diagnosis of ligamentous lesions of the ankle dynamic projections.

Functional radiographic investigation is indispensable to the clinical examination of ligamentous lesions of the ankle. It facilitates correct classification of the different lesions. This correlation of clinical findings and precise radiographical images to well defined anatomo-pathological lesions is particularly important in selecting the correct treatment. An apparatus is described which makes it possible to identify more precisely ligamentous lesions of the ankle, both the abnormal tilting of the talus in A.P. views, and forward talar sliding ("angle of ballottamento") seen in lateral views. This apparatus is easy to use in the First Aid department and can be used without general or local anaesthesia.

Operative indications in fractures of the calcaneus: problems of reduction and fixation.

In fractures of the calcaneus the fundamental importance of complete restoration of the architectural structure of the bone is stressed. To this end, the technique of internal fixation calls for a special device. Three different types of plate are described and the indications for each discussed.