| Background:Chronic osteomyelitis of calcaneus is not rare but is very hard to treat.Irrigation-suction and antibiotic impregnated calcium sulfate following debridement are commonly used in managing chronic osteomyelitis,but their efficacies have rarely been compared.We aimed to compare the effectiveness of antibiotic-impregnated calcium sulfate with irrigation-suction in the treatment of patients with chronic calcaneal osteomyelitis.Methods:From January 2011 to June 2018,adult patients at our institute with chronic osteomyelitis receiving treatment of either antibiotic-impregnated calcium sulfate(CS group)or irrigation-suction(IS group)following thorough debridement were screened and selected according to the inclusion and exclusion criteria.The clinical symptoms,laboratory examinations,complications,and the ultimate single-staged cure rate and recurrence were compared.Results:A total of 61 patients,including 41 in the CS group and 20 in the IS group,were included in our study.Of the patients,85.4%in the CS group and 60.0%in the IS group(P=.006)were successfully cured in the single stage,respectively,without infection recurrence.Lower infection recurrence rates with shorter hospital stay were found in the CS group than the IS group.Inflammatory biomarkers after surgery with both treatments were slightly decreased and not significantly different from preoperative or between-groups postoperative.Exudate from incision was found primarily in the CS group.Conclusions:This study certifies that both antibiotic-impregnated calcium sulfate and irrigation-suction after careful and thorough surgical debridement are both effective in treating chronic calcaneal osteomyelitis.Antibiotic-impregnated calcium sulfate achieved a higher single-staged cure rate but was associated with an increased postoperative wound exudate.Background:The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures.However,appropriate treatment for infection after intramedullary nailing is unclear.The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing:intramedullary nail removal,local debridement,reaming and irrigation,and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis.Methods:We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2018 at our hospital.Patients with follow-up of less than 24 months,received other treatment methods,or those with serious medical conditions were excluded from the analysis.Patients met the criteria were treated as described above,followed by distraction osteogenesis in 9 cases to repair bone defect.The infection remission rate,infection recurrence rate,and post-operative complication rates were assessed.Results:A total of 19 patients were included in the analysis.All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months(range,24 to 55 months).Eighteen patients(94.7%)achieved infection control;1 patient(5.3%)developed a reinfection that resolved after repeat debridement.Nine patients with bone defects(average size 4.7±1.3 cm;range,3.3 to 7.6 cm)were treated with bone transport which successfully restored the length of involved limb.The mean bone transport duration was 10.7±4.0 months(range,6.7 to 19.5 months).The majority of patients achieved full weight bearing and became pain free during the follow-up period.The main postoperative complications were long-term wound drainage(7/19;36.8%),re-fracture(1/19;5.3%)and joint stiffness,which were successfully managed by regular dressing changes and re-fixation,respectively.Conclusion:Intramedullary nail removal,Intramedullary reaming and irrigation,and antibiotic-impregnated calcium sulfate implantation(with or without distraction osteogenesis)is effective for treating infections after intramedullary nailing. |
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