[Clinical experience of an offloading orthosis to prevent and heal diabetic foot ulcers of the digits]. / Expérience clinique d'une orthèse de décharge pour prévenir et guérir les ulcères digitaux du pied diabétique.

Globally, every 30 seconds a lower limb amputation is carried out due to diabetes, in 85 % of cases preceded by a foot ulcer. One of the main causes of foot ulcer formation is abnormal mechanical pressure and shear, the alleviation of which is therefore a key element in the management of diabetic foot ulcers. The toes, often neglected in routine clinical examinations, are particularly vulnerable because of the thin soft tissue between the bones and the skin and because of trauma due to ill-fitting shoes. The orthosis described in this article provides effective protection of protruding and injured areas while being comfortable to wear with everyday shoes and compatible with an active lifestyle. When correctly designed, worn and monitored, it has the potential to prevent and heal diabetic ulcers of the Hallux and the lesser toes.

Toutes les 30 secondes, une personne dans le monde subit une amputation du membre inférieur due au diabète, précédée dans 85 % des cas d'un ulcère au pied. L'allègement d'une pression mécanique néfaste est un élément clé dans la prise en charge du pied diabétique. Les orteils, souvent négligés dans l'examen clinique, sont particulièrement vulnérables en raison de la minceur des tissus mous entre les os et la peau et à cause des chaussures potentiellement nuisibles car inadaptées à la forme et au volume de l'avant-pied. L'orthèse de décharge décrite dans cet article assure une protection efficace des zones saillantes et lésées tout en étant confortable à porter et compatible avec une vie active. Conçue et portée correctement, elle a le potentiel de prévenir et guérir les ulcères digitaux du pied diabétique.

Additional muscular slip of the flexor digitorum longus muscle to the fifth toe.

Despite the fact that there are numerous reports on muscular variations in the sole of the foot, routine dissection in a formaldehyde-fixed cadaver revealed an accessory flexor digiti quinti muscle, which to the best of our knowledge is a very unusual variant. This was in the form of a slender, 38 mm long muscular slip, with a proximal and distal tendon extending from the common flexor digitorum longus tendinous plate out to the distal phalanx of the fifth toe. An associated finding was the absence of the musculotendinous portion of the flexor digitorum brevis to the same toe. A developmental explanation for this variation is presented. Clinical implications with regard to this anatomical condition may result in clawing of the fifth toe.

Calcified desmoplastic fibroblastoma of the foot: imaging findings.

We report a case of desmoplastic fibroblastoma (DF) of the foot in a 65-year-old woman. The tumor presented as a slow-growing, painless mass located in the first intermetatarsal space of the right foot. Ultrasound showed a well-circumscribed hypoechoic lesion containing hyperechoic calcifications confirmed on standard radiographs. At magnetic resonance imaging (MRI), the mass appeared isointense to the muscles on T1-weighted (T1W) images, hyperintense on proton-density-weighted fat-saturated images, and presented scattered internal hypointense foci. Post-contrast T1W spectral presaturation with inversion recovery (SPIR) images showed heterogeneous, mostly peripheral, contrast enhancement. DF must be considered in the differential diagnosis of soft-tissue calcified tumors of the foot.

Technique tip: Simultaneous first metatarsal lengthening and metatarsophalangeal joint fusion for failed hallux valgus surgery with transfer metatarsalgia.

BACKGROUND: Failed hallux valgus surgery may result in residual or recurrent hallux valgus, and as well transfer metatarsalgia. The present technical tip concerns the combination of fusion of the first metatarsophalangeal (MTP) joint and lengthening of the first metatarsal (MT) through a scarf osteotomy. MATERIALS AND METHODS: Six patients underwent the presented technique, all for the indication of failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. RESULTS: Follow-up at six months revealed all patients had complete healing of the osteotomy and arthrodesis sites. They were all asymptomatic and fully active, completely satisfied with the outcome. CONCLUSIONS: Combined fusion of the first MTP joint and lengthening of the first MT through a scarf osteotomy results in an excellent outcome in patients with failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint.

[Evidence based treatment of hallux valgus]. / Traitement de l'hallux valgus basé sur l'évidence.

Hallux valgus is a frequent disorder of the foot and decision-making about the best treatment provokes many questions among patients and specialists. These include the need for surgery, which surgical technique is the best choice, and is minimally invasive surgery going to replace open techniques? While the modern media provides patients with easy access to details concerning surgical techniques, they rarely include means for the patient to distinguish between objective information and publicity. The general practitioner is a person of trust for the patient and should help him or her consider treatment proposals. With these factors in mind, the aim of this paper is to share the evidence-based information regarding the treatment of hallux valgus with the general practitioner.

L'hallux valgus est une pathologie du pied fréquente et sa prise en charge suscite actuellement beaucoup de questions tant parmi les patients que parmi les experts. La chirurgie est-elle indispensable ? A quel moment faut-il opérer ? Quelle technique utiliser ? La chirurgie mini-invasive va-t-elle remplacer les techniques ouvertes ? Les médias modernes permettent aux patients un accès facile aux détails concernant les techniques chirurgicales existant sur le marché, sans pour autant leur donner des moyens de distinction entre l'information objective et la promotion. Le médecin traitant est un spécialiste de confiance vers lequel le patient doit pouvoir se tourner avant d'accepter une proposition thérapeutique. C'est pourquoi, et c'est le but de cet article, il nous paraît essentiel de partager la connaissance du traitement de l'hallux valgus basée sur l'évidence avec le médecin traitant.

[Ankle fractures in the elderly patient]. / Fractures de la cheville chez le patient âgé.

Ankle fractures in adults are usually managed by open reduction internal fixation. In elderly patients the surgical dilemma relates to bone quality. Osteoporosis is the enemy of internal fixation, and secure purchase of screws in osteopenic bone may be difficult to achieve. Insufficient screw purchase may lead to loss of reduction, wound breakdown, and infection. Postoperative management after osteosynthesis usually requires an extended period of restricted weight bearing. However, this is not feasible in older patients as a result of their lack of strength in the upper extremities and frequent comorbidities. Therefore, augmen- ted methods of internal fixation and specific surgical techniques have been developed using metal and bone cement. This permits this fragile population to begin early full weight bearing in a removable brace.

Comparison of the International Committee of the Red Cross foot with the solid ankle cushion heel foot during gait: a randomized double-blind study.

OBJECTIVE: To compare the well-recognized solid ankle cushion heel (SACH) foot with the prosthetic foot developed by the International Committee of the Red Cross (CR Equipements SACH) during gait. DESIGN: Double-blind study was conducted to compare the influence on the biomechanics of gait of the CR Equipements SACH foot and the SACH foot. SETTING: University hospital research center. PARTICIPANTS: Participants with unilateral transtibial amputation (N=15) were included. INTERVENTIONS: Three-dimensional motion analysis system and 2 forceplates were used to capture body motion and ground reaction forces during gait at a self-selected speed and at 1.2m/s. MAIN OUTCOME MEASURES: Nonparametric Wilcoxon matched-pairs tests were used to compare the 2 prosthetic feet with respect to their spatiotemporal (gait velocity, stride length, and percentage of stance phase), kinematic (range and peak angles of the pelvis, hip, knee, and ankle), and kinetic (peak moment and power of the hip, knee, and ankle) parameters. RESULTS: Compared with the SACH foot, the CR Equipements SACH foot demonstrated a significantly greater stance phase symmetry ratio (SACH: 94% vs CR Equipements SACH: 97%), a more extensive ankle range of motion in the sagittal plane (SACH: 7° vs CR Equipements SACH: 12°), a greater maximal dorsiflexion angle during the terminal stance phase (SACH: 10° vs CR Equipements SACH: 13°), and a higher ankle power (SACH: .31W/kg vs CR Equipements SACH: .40W/kg). No significant difference was found for the examined knee, hip, and pelvis parameters. CONCLUSIONS: The CR Equipements SACH foot provides more symmetry and improves ankle kinematics and kinetics in the sagittal plane compared with the SACH foot. This study suggests that individuals using the CR Equipements SACH foot improve their gait biomechanics compared when using the SACH foot.

Do Patients With Functional Hallux Limitus Have a Low-Lying or Bulky FHL Muscle Belly?

Background: Functional hallux limitus (FHLim) refers to a limitation of hallux dorsiflexion when the first metatarsal head is under load, whereas physiologic dorsiflexion is measured in the unloaded condition. Limited excursion of the flexor hallucis longus (FHL) in the retrotalar pulley has been identified as a possible cause of FHLim. A low-lying or bulky FHL muscle belly could be the cause of this limitation. However, to date, there are no published data regarding the association between clinical and anatomical findings. The purpose of this anatomical study is to correlate the presence of FHLim and objective morphologic findings through magnetic resonance imaging (MRI). Methods: Twenty-six patients (27 feet) were included in this observational study. They were divided into 2 groups, based on positive and negative Stretch Tests. In both groups, we measured on MRI the distance from the most inferior part of the FHL muscle belly and the retrotalar pulley as well as the cross-sectional area of the muscle belly 20, 30, and 40 mm proximal to the retrotalar pulley. Results: Eighteen patients had a positive Stretch Test and 9 patients had a negative Stretch Test. The mean distance between the most inferior part of the FHL muscle belly and the retrotalar pulley was 6.0 ± 6.4 mm for the positive group and 11.8 ± 9.4 mm for the negative group (P = .039). The mean cross section of the muscle measured at 20, 30, and 40 mm from the pulley were 190 ± 90, 300 ± 112, and 395 ± 123 mm2 for the positive group and 98 ± 44, 206 ± 72, and 294 ± 61mm2 for the negative group (P values .005, .019, and .017). Conclusion: Based on these findings, we can conclude that patients with FHLim do have a low-lying FHL muscle belly causing limited excursion in the retrotalar pulley. However, the mean volume of the muscle belly was comparable in both groups, and therefore bulkiness was not found to be a contributing factor. Level of Evidence: Level III, observational study.

Articular Cartilage Repair After Implantation of Hyaline Cartilage Beads Engineered From Adult Dedifferentiated Chondrocytes: Cartibeads Preclinical Efficacy Study in a Large Animal Model.

BACKGROUND: Chondrocyte-based cell therapy to repair cartilage has been used for >25 years despite current limitations. This work presents a new treatment option for cartilage lesions. HYPOTHESIS: High-quality hyaline cartilage microtissues called Cartibeads are capable of treating focal chondral lesions once implanted in the defect, by complete fusion of Cartibeads among themselves and their integration with the surrounding native cartilage and subchondral bone. STUDY DESIGN: Controlled laboratory study. METHODS: Cartibeads were first produced from human donors and characterized using histology (safranin O staining of glycosaminoglycan [GAG] and immunohistochemistry of collagen I and II) and GAG dosage. Cartibeads from 6 Göttingen minipigs were engineered and implanted in an autologous condition in the knee (4 or 5 lesions per knee). One group was followed up for 3 months and the other for 6 months. Feasibility and efficacy were measured using histological analysis and macroscopic and microscopic scores. RESULTS: Cartibeads revealed hyaline features with strong staining of GAG and collagen II. High GAG content was obtained: 24.6-µg/mg tissue (wet weight), 15.52-µg/mg tissue (dry weight), and 35 ± 3-µg GAG/bead (mean ± SD). Histological analysis of Göttingen minipigs showed good integration of Cartibeads grafts at 3 and 6 months after implantation. The Bern Score of the histological assay comparing grafted versus empty lesions was significant at 3 months (grafted, n = 10; nongrafted, n = 4; score, 3.3 and 5.3, respectively) and 6 months (grafted, n = 11; nongrafted, n = 3; score, 1.6 and 5.1). CONCLUSION: We developed an innovative 3-step method allowing, for the first time, the use of fully dedifferentiated adult chondrocytes with a high number of cell passage (owing to the extensive amplification in culture). Cartibeads engineered from chondrocytes hold potential as an advanced therapy medicinal product for treating cartilage lesions with established efficacy. CLINICAL RELEVANCE: This successful preclinical study, combined with standardized manufacturing of Cartibeads according to good manufacturing practice guidelines, led to the approval of first-in-human clinical trial by the ethics committee and local medical authority. The generated data highlighted a promising therapy to treat cartilage lesions from a small amount of starting biopsy specimen. With our innovative cell amplification technology, very large lesions can be treated, and older active patients can benefit from it.

Conditions found among pediatric survivors during the early response to natural disaster: a prospective case study.

BACKGROUND: Major natural disasters may provoke a mass casualty situation, and children tend to represent an important proportion of the victims. The purpose of this study was to prospectively record medical conditions presented by pediatric survivors of a major natural disaster to determine the type of medical specialists most needed during the acute phase of relief response. METHODS: After the 2010 Haiti earthquake, age, sex, date of presentation, diagnosis, and treatment provided were prospectively recorded for all patients less than 18 years old treated by a medical relief team. Patients were then allocated to 1 of the 2 groups: surgical (traumatism or surgical disorder) and medical (medical disorder). Medical activity lasted for 43 days. RESULTS: Four hundred seventy-one of the 796 treated patients were less than 18 years old. Two hundred forty-four (52%) were assigned to the surgical group and 227 (48%) to the medical group. As there was a substantial decrease in the number of new surgical patients registered on day 11 of activity, we arbitrarily defined an early period (until day 10 of activity) and a late period (beginning on day 11 of activity). Data obtained from the 147 new patients registered during the early period revealed 134 (91%) surgical patients and 13 (9%) medical patients. Eighty-eight percent of patients needed specialized care for traumatic orthopaedic lesions, and procedures under anesthesia or sedation were mainly (98%) performed for traumatic conditions. Data obtained for the 324 new patients registered during the late period revealed 110 (34%) surgical patients and 214 (66%) medical patients. There was a switch from high surgical needs to more routine medical and surgical care, with less procedures (88%) for the treatment of traumatic lesions. CONCLUSIONS: Pediatric orthopaedic surgeons have a major role to play in the acute phase of relief response to potentially minimize long-term physical and psychosocial disability associated with these complex injuries in growing patients. LEVEL OF EVIDENCE: Economic or decision analyses, level II.

Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use.

BACKGROUND: Optimal duration of antibiotic prophylaxis following major lower limb amputation in preventing adverse stump outcomes is controversial. OBJECTIVE: We assess the epidemiology and risk factors of wound dehiscence and stump infection after mid-thigh to transmetatarsal amputations with regard to antibiotic administration. METHODS: Our retrospective observational study at the Geneva University Hospital (January 1995-June 2010) includes a total of 289 amputations in 270 adult patients (199 males; median age 70 years). RESULTS: Wound dehiscence and/or stump infection occurred in 47 (16.3%) and 63 (21.8%) patients with a median delay of 24 and 14 days, respectively. No clinical variable was significantly associated with stump infection. Diabetes and older age (>80 years) were associated with dehiscence. Importantly, transcutaneous tissue oxygen tension (TcPO2) and duration of antibiotic administration showed no association with either outcome. CONCLUSION: The duration of antibiotic administration before or after surgery does not change the epidemiology of stump complications.

Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study.

PURPOSE: Long-term studies evaluating risk factors for development of ankle osteoarthritis (OA) following malleolar fractures are sparse. METHODS: We conducted a retrospective cohort study including consecutive patients treated by open reduction and internal fixation for malleolar fracture between January 1988 and December 1997. Perioperative information was obtained retrospectively. Patients were evaluated clinically and radiographically 12-22 years postoperatively. Radiographic ankle OA was determined on standardised radiographs using the Kellgren and Lawrence scale (grade 3-4=advanced OA). Uni- and multivariate regression analyses were performed to determine risk factors for OA. RESULTS: During the inclusion period, 373 fractures (372 patients; 9% Weber A, 58% Weber B, 33% Weber C) were operated upon. The mean age at operation was 42.9 years. There were 102 patients seen at follow-up (mean follow-up 17.9 years). Those not available did not differ in demographics and fracture type from those seen. Advanced radiographic OA was present in 37 patients (36.3%). Significant risk factors were: Weber C fracture, associated medial malleolar fracture, fracture-dislocation, increasing body mass index, age 30 years or more and length of time since surgery. CONCLUSIONS: Advanced radiographic OA was common 12-22 years after malleolar fracture. The probability of developing post-traumatic OA among patients having three or more risk factors was 60-70%.

Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study.

PURPOSE: Osteoarticular infections due to methicillin-susceptible Staphylococcus aureus (MSSA) or its methicillin-resistant variant (MRSA) are feared due to treatment failures. According to clinical experience, Pseudomonas aeruginosa may reveal less long-term remission than S. aureus. METHODS: A case-controlled study comparing outcomes of osteoarticular infections due to P. aeruginosa vs S. aureus was performed at Geneva University Hospitals. RESULTS: A total of 111 S. aureus (including 37 MRSA) and 20 P. aeruginosa osteoarticular infections were analysed in 131 patients: arthroplasties (n = 38), fracture fixation devices (n = 56), native joint arthritis (n = 7) and osteomyelitis without implant (n = 30). The median active follow-up time was 4 years. The patients underwent a median number of two surgical interventions for P. aeruginosa infections compared to two for S. aureus (two for MRSA), while the median duration of antibiotic treatment was 87 days for P. aeruginosa and 46 days for S. aureus infections (58 days for MRSA) (all p > 0.05). Overall, Pseudomonas-infected patients tended towards a lower remission rate than those infected with S. aureus (12/20 vs 88/111; p = 0.06). This was similar when P. aeruginosa was compared with MRSA alone (12/20 vs 30/37; p = 0.08). In multivariate logistic regression analyses adjusting for case mix, odds ratios (OR) for remission were as follows: P. aeruginosa vs S. aureus [OR 0.4, 95% confidence interval (CI) 0.1-1.2], number of surgical interventions (OR 0.6, 95% CI 0.5-1.0) and duration of antibiotic treatment (OR 1.0, 95% CI 1.0-1.0). CONCLUSIONS: Despite a similar number of surgical interventions and longer antibiotic treatment, osteoarticular infections due to P. aeruginosa tended towards a lower remission rate than infections due to S. aureus in general or MRSA in particular.

Iatrogenic transfer metatarsalgia after hallux valgus surgery: a comprehensive treatment algorithm.

Current literature has described many of the complications following hallux valgus surgery and their treatment options. Iatrogenic transfer metatarsalgia is a distinctive and challenging complication that has not been addressed in a comprehensive fashion yet. Iatrogenic transfer metatarsalgia may result from poor preoperative assessment, planning and/or surgical technique. We have classified the causes of iatrogenic transfer metatarsalgia based on a multiplanar assessment of the malalignment(s) and are recommending a comprehensive treatment algorithm to guide surgeons in addressing this complication. With this knowledge, surgeons may avoid potential pitfalls in the primary surgery that can result in iatrogenic transfer metatarsalgia and find the appropriate treatment option to correct them.

Hyaline Cartilage Microtissues Engineered from Adult Dedifferentiated Chondrocytes: Safety and Role of WNT Signaling.

The repair of damaged articular cartilage is an unmet medical need. Chondrocyte-based cell therapy has been used to repair cartilage for over 20 years despite current limitations. Chondrocyte dedifferentiation upon expansion in monolayer is well known and is the main obstacle to their use as cell source for cartilage repair. Consequently, current approaches often lead to fibrocartilage, which is biomechanically different from hyaline cartilage and not effective as a long-lasting treatment. Here, we describe an innovative 3-step method to engineer hyaline-like cartilage microtissues, named Cartibeads, from high passage dedifferentiated chondrocytes. We show that WNT5A/5B/7B genes were highly expressed in dedifferentiated chondrocytes and that a decrease of the WNT signaling pathway was instrumental for full re-differentiation of chondrocytes, enabling production of hyaline matrix instead of fibrocartilage matrix. Cartibeads showed hyaline-like characteristics based on GAG quantity and type II collagen expression independently of donor age and cartilage quality. In vivo, Cartibeads were not tumorigenic when transplanted into SCID mice. This simple 3-step method allowed a standardized production of hyaline-like cartilage microtissues from a small cartilage sample, making Cartibeads a promising candidate for the treatment of cartilage lesions.

Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening.

BACKGROUND: Surgery is frequently considered an option for refractory, symptomatic noninsertional Achilles tendinopathy. Gastrocnemius equinus can result in mechanical overload of the Achilles tendon and may be a factor in its etiology. Our hypothesis was that reducing load transmission to the Achilles tendon by gastrocnemius lengthening (Strayer procedure) may be an effective treatment. MATERIALS AND METHODS: A prospective case series of all patients with a minimum 1-year symptomatic noninsertional Achilles tendinopathy who underwent gastrocnemius lengthening was evaluated before surgery, and at 1 and 2 years after surgery. There were 14 patients (17 tendons). RESULTS: One year after surgery, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 100 points, as compared to 71 points preoperatively (p < 0.001). The median total Foot Function Index (FFI) decreased significantly from 39 to 12 points at 1 year (p < 0.001) and remained stable (12 points) at 2 years. An electronic goniometer recorded a mean gain in ankle dorsiflexion of 13 degrees. At 1 year after surgery the MRI in all eight patients (ten tendons) with a preoperative MRI demonstrated a decrease in signal hyperintensity and tendon size, signifying an improvement of the tendinopathy. At 2 years after surgery, patient satisfaction assessment revealed that all but one patient was satisfied with the result and 11 of the 14 (79%) patients were able to resume their previous sporting activities. There were no complications. CONCLUSION: Gastrocnemius lengthening was an effective treatment for chronic Achilles noninsertional tendinopathy. Two-year results show good to excellent clinical outcome.

Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience.

PURPOSE: The optimal duration of concomitant antibiotic therapy after surgical intervention for implant-free chronic osteomyelitis is unknown. No randomized data exist. Available recommendations are based on expert's opinion. We evaluated the duration of post-surgical antibiotic treatment related to remission of chronic osteomyelitis. METHODS: This was a retrospective single-centre study at Geneva University Hospitals with a minimal follow-up of two years after treatment. We used multivariate logistic regression analysis with exclusion of pediatric cases and of implant-related chronic osteomyelitis. RESULTS: A total of 49 episodes of implant-free chronic osteomyelitis in 49 adult patients were studied. The median number of surgical interventions was two (range, 1-10). The median duration of post-debridement antibiotic treatment was eight weeks (range, 4-14 weeks). Thirty-nine patients (80%) were in remission after a minimal follow-up of two years. In multivariate logistic regression analysis, one week of intravenous therapy had the same remission as two to three weeks (0.2, 0.1-1.9) or ≥ 3 weeks (0.3, 0.1-2.4). More than six weeks of total antibiotic treatment equalled ≤  six weeks (0.8, 0.1-5.2). CONCLUSIONS: In chronic osteomyelitis in adults, a post-debridement antibiotic therapy beyond six weeks, or an IV treatment longer than one week, did not show enhanced remission incidences. Prospective randomized trials are required to confirm this observation.

Step activity monitoring to assess ambulation before and after total ankle arthroplasty.

BACKGROUND: The study objective was to compare walking activity before and after total ankle arthroplasty (TAA). METHODS: Nineteen patients who underwent TAA were prospectively reviewed with a dedicated ambulatory activity-monitoring device. Patients were tested 1 month prior to surgery, and at least 18 months post-operative. Ambulatory parameters included number of steps at different cadences and time spent walking at different paces. The American Orthopaedic Foot and Ankle (AOFAS) hindfoot scale was assessed at similar intervals. RESULTS: Following TAA, there was significant improvement in the number of steps walked at normal cadence, while importantly the number of steps walked at low and medium cadence decreased. There was no significant difference between the time actually spent walking at any cadence after arthroplasty. The mean AOFAS hindfoot scale significantly improved. CONCLUSIONS: Following TAA, patients show an improved walking pace and AOFAS hindfoot scale, but no difference in the amount of time spent walking.

Computer-assisted surgery and navigation in foot and ankle: state of the art and fields of application.

Computer-assisted orthopaedic surgery (CAOS) is a real-time navigation guidance system that supports surgeons intraoperatively.Its use is reported to increase precision and facilitate less-invasive surgery.Advanced intraoperative imaging helps confirm that the initial aim of surgery has been achieved and allows for immediate adjustment when required.The complex anatomy of the foot and ankle, and the associated wide range of challenging procedures should benefit from the use of CAOS; however, reports on the topic are scarce.This article explores the fields of applications of real-time navigation and CAOS in foot and ankle surgery. Cite this article: EFORT Open Rev 2021;6:531-538. DOI: 10.1302/2058-5241.6.200024.

Infectious olecranon and patellar bursitis: short-course adjuvant antibiotic therapy is not a risk factor for recurrence in adult hospitalized patients.

OBJECTIVES: No evidence-based recommendations exist for the management of infectious bursitis. We examined epidemiology and risk factors for recurrence of septic bursitis. Specifically, we compared outcome in patients receiving bursectomy plus short-course adjuvant antibiotic therapy (7 days). PATIENTS AND METHODS: Retrospective study of adult patients with infectious olecranon and patellar bursitis requiring hospitalization at Geneva University Hospital from January 1996 to March 2009. RESULTS: We identified 343 episodes of infectious bursitis (237 olecranon and 106 patellar). Staphylococcus aureus predominated among the 256 cases with an identifiable pathogen (85%). Three hundred and twelve cases (91%) were treated surgically; 142 (41%) with one-stage bursectomy and closure and 146 with two-stage bursectomy. All received antibiotics for a median duration of 13 days with a median intravenous component of 3 days. Cure was achieved in 293 (85%) episodes. Total duration of antibiotic therapy [odds ratio (OR) 0.9; 95% confidence interval (95% CI) 0.8-1.1] showed no association with cure. In multivariate analysis, only immunosuppression was linked to recurrence (OR 5.6; 95% CI 1.9-18.4). Compared with 14 days of antibiotic treatment (OR 0.9; 95% CI 0.1-10.7) was equivalent, as was the intravenous component (OR 1.1; 95% CI 1.0-1.3). CONCLUSIONS: In severe infectious bursitis requiring hospitalization, adjuvant antibiotic therapy might be limited to 7 days in non-immunosuppressed patients.