[One-stage management of infected nonunion using granulated cancellous bone autografting after debridement].

OBJECTIVE: To investigate the curative effect of treating infected nonunion with debridement and granulated cancellous bone autografting in a one-stage procedure. METHODS: Between 1999 and 2005, 38 cases of infected nonunion were treated with immediate granulated cancellous bone autografting after debridement. RESULTS: At a mean follow-up of 44 months (range: 12 to 93), 33/38 (86.8%) had an excellent outcome, 5 (13.2%) developed infectious recurrent and/or persistent nonunion (1 case with infectious recurrence and persistent nonunion). Two patients suffered refracture after removing external fixator. CONCLUSION: The success rate of treating infected nonunion with debridement and granulated cancellous bone autografting in one-stage is high.

[Treatment of infected nonunion with large skeletal defects].

OBJECTIVE: To investigate the curative effect of managing infected nonunion with large skeletal defects utilizing debridement and granulated cancellous bone grafting. METHODS: Nineteen patients (20 sites) of infected nonunion with large skeletal defects in tibiae (n = 18) or ulna/radii (n = 2), 18 males and 1 female aged 31.3 (8 - 51), were treated with debridement, external fixation, and granulated cancellous bone grafting, 14 patients (15 sites) by cancellous bone autografting and 5 patients (5 sites) by cancellous bone allografting. Follow-up was conducted for 32.7 (20 - 56) months. RESULTS: Out of the 5 patients receiving allografting, 3 gained bone union with an external fixator index of (2.22 +/- 0.84) months/cm, 2 developed nonunion and subsequently gained union after receiving cancellous bone autografting, and no infection recurrence all of the 5 patients were found. Out of the 14 patients (15 sites) undergoing autografting, 2 patients (2 sites, 13.3%) developed nonunion due to recurrent infection resulting in absorption of autograft, subsequently received debridement and autografting once again, and gained bone union and infection eradication; 12 patients (13 sites, 86.7%) gained bone union with an external fixator index: of (1.96 +/- 0.74) months/cm. Re-fracture occurred in 3 patients (4 sites) and was cured by using cast immobilization (1 case), external fixator (1 case), or internal fixation (1 case). CONCLUSION: Granulated cancellous bone autografting is a suitable method for managing infected nonunion with large skeletal defects. And cancellous bone allografting has a higher incidence of re-nonunion and longer time for using external fixator.

[Prospective cohort study on the relationship between pathogenic bacteria in the nasal middle meatus and acute bacterial respiratory infection in children].

OBJECTIVE: To study the relationship between pathogenic bacteria in the nasal middle meatus and acute bacterial respiratory infection in children. METHODS: Three hundred and twenty eight children with respiratory infection (mean age 8 years) were included into the prospective cohort study. The mucosal fluid specimens from the nasal middle meatus were collected under an endoscope for bacterial culture. The patients with bacterial culture positive were defined as the Exposed group and those with bacterial culture negative as the Non-exposed group. The grouping of the patients was blinded to the patients, patients' parents and physicians. Both groups received anti-virus and symptomatic treatments, without antibiotic administration. Five days later, the patients were evaluated as to whether they had bacterial infection based on the leucocyte count and CRP results. RESULTS: Of the 328 patients, 168 had a positive nasal bacterial culture. The incidence of bacterial respiratory infection in the Exposed group [51.2% (86/168)] was significantly higher than in the Non-exposed group [13.1% (21/160)] (P < 0.01). The relative risk of bacterial respiratory infection occurrence in patients with nasal bacterial culture positive was 3.9002. CONCLUSIONS: The children with respiratory infection who had potential pathogenic bacteria in the nasal middle meatus were more prone to develop bacterial respiratory infection.

Treatment of chronic osteomyelitis with one-stage allograft.

OBJECTIVE: To avoid disadvantages of two-stage cancellus bone autograft, we investigated the feasibility of one-stage allograft for reconstructing the bone defect resulting from debridement of chronic osteomyelitis in limbs. METHODS: Between Feb. 1999 and Apr. 2004, 35 cases of chronic osteomyelitis (8 cases of nonunion) underwent one-stage allograft after debridement in our hospital. RESULTS: Thirty-five cases were followed up for an average period of 28 months (range, 13 to 55 months), in which 32 cases (91.43%) were found no infection, and 3 cases (8.57%) were confirmed recurrence of infection. Four out of 8 cases of bone nonunion healed in 9.5 months on average (range, 3 to 12 months), and another case also acquired union after redebridement and autograft of ilium due to infection recurrence 35 days after surgery. Renonunion occurred in 3 cases, 2 out of whom healed after secondary operation with autograft. One case of renonunion and 2 cases of infection recurrence refused further treatment. CONCLUSIONS: A high rate of infection arrest can be attained when one-stage allograft is used to reconstruct the bone defect of chronic osteomyelitis after debridement in limbs. Therefore, chronic osteomyelitis should not be regarded as a contraindication to one-stage allogeneic bone grafting. Renonuion, however, achieves a relatively high rate, especially in cases of segmental bone defect.