The role of bioactive glass in the management of chronic osteomyelitis: a systematic review of literature and current evidence.

Background: The increase of orthopaedic surgical interventions has given rise to an increased prevalence of chronic osteomyelitis. The principles of management of chronic osteomyelitis are well defined and include a thorough debridement, dead space management followed by an adequate period of appropriate antibiotics. Bioactive glass has garnered interest in recent years as a potential void filler following debridement. In the present systematic review, we explore the role of bioactive glass as a dead space management agent following debridement of chronic osteomyelitis.Methods: A search was made for all the articles pertaining to the role of bioactive glass in chronic osteomyelitis. The keywords used for search in PUBMED/MEDLINE were 'Bioactive glass' and 'chronic osteomyelitis'. A total of nine publications evaluating the outcome of 206 patients were included for evaluation.Results: The overall cure rate was 86% with 24 patients (11.6%) experiencing recurrence, while five patients were lost to follow-up. Out of the total 24 recurrences or persistent infections, 10 were associated with poor post-operative wound healing which progressed to recurrence.Conclusions: Bioactive glass appears to provide an attractive alternative for bone void filling after debridement of chronic osteomyelitis with good long-term outcomes. Potential advantages include a unique mechanism of anti-microbial action rendering it active against multi-drug resistant bacteria, use as a single stage procedure and gradual replacement by bone.

[The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis].

The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years. The study has demonstrated the effectiveness of the inclusion of IRLR in the medical rehabilitation program for the children with chronic hematogenous osteomyelitis in different periods of the disease. It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process. The application of IRLR in combination with fluctuation magnetic therapy during the period of partial remission, had a more pronounced influence on the microcirculation and stimulated the regenerative and trophic processes.

Prosthetic rehabilitation of acquired maxillary defects secondary to mucormycosis: clinical cases.

Maxillary necrosis can occur due to bacterial infections such as osteomyelitis, viral infections, such as herpes zoster or fungal infections, such as mucormycosis, aspergillosis etc. Mucormycosis is an opportunistic fungal infection, which mainly infects immunocompromised patients. Once the maxilla is involved, surgical resection and debridement of the necrosed areas can result in extensive maxillary defects. The clinician is to face many a challenge in order to replace not only the missing teeth, but also the lost soft tissues and bone, including hard palate and alveolar ridges. The prosthesis (Obturator) lacks a bony base and the lost structures of the posterior palatal seal area compromise retention of the prosthesis. Furthermore, the post surgical soft tissues are scarred and tense, which exert strong dislodging forces. The present article describes the prosthetic rehabilitation of maxillary necrosis secondary to mucormycosis in two cases, one completely edentulous and the other partially edentulous.

Utilidad de los espaciadores de cemento con antibióticos en la cirugía séptica del hombro, a propósito de dos casos clínicos / Utility of antibiotic-impregnated cement spacers in septic surgery of the shoulder, a propos of two clinical cases

Presentamos dos casos tratados mediante desbridamiento, retirada de material y colocación de espaciador cementado para húmero proximal con gentamicina, valorando aspectos analíticos, radiológicos y clínicos. La evolución de los pacientes tuvo un buen resultado final. La osteomielitis de húmero proximal es una complicación que ensombrece el pronóstico funcional del hombro. El tratamiento con retirada de material (de osteosíntesis o protésico) y la colocación de un espaciador de cemento pueden ser alternativas a esta temida complicación (AU)

We present two cases treated by debridement, removal of unwanted material and placement of a cemented spacer for the proximal humerus impregnated with gentamycin, assessing laboratory, radiological and clinical aspects. Patients had a satisfactory course with a good final result. Osteomyelitis of the proximal humerus is a complication that leads to a dismal functional prognosis of the shoulder. Treatment with removal of unwanted material (osteosynthetic or prosthetic) and placement of a cement spacer may be alternatives to this dreaded complication (AU)

Covering the below-knee amputation stump with the pedicled dorsalis pedis flap from the ipsilateral foot: a case report.

It is important to preserve the length, appropriate durable skin, and sensation of the stump when performing below-knee amputation to achieve functional ambulation with a prosthesis. There are many reports of reconstruction procedures using microvascular surgery to preserve the optimum length of the amputation stump for prosthesis; however, free tissue reconstruction is necessary to accompany with the donor site morbidity. In this report, we describe our experience with a below-knee amputation and stump covering using the pedicled dorsalis pedis flap from the no longer usable foot in the case of a severe osteomyelitis of a lower extremity after highly contaminated Gustilo type IIIB fracture. We achieved a well-healed amputated stump with enough length for a prosthesis and for protective sensation. The pedicled dorsalis pedis flap is easily elevated without microvascular anastomosis and is one useful option for the reconstruction of the below-knee amputated stump in the specific case.

Residual limb osteomyelitis: a case series from a national prosthetic centre.

PURPOSE: To examine the impact of residual limb osteomyelitis (RLO) on the rehabilitation of lower limb amputees. METHOD: Retrospective review of the case notes of patients with RLO. Information sought included details of amputation, clinical features of investigations for and management of RLO and its effect on rehabilitation. RESULTS: There were seven transfemoral and three transtibial amputees. Indications for amputation were vascular disease in nine cases, trauma in one. In each case, delayed wound healing or residual limb pain prompted radiological, hematological and microbiological investigations. Average time between amputation and diagnosis was 187 days. One patient died before treatment commenced. Two transtibial amputees were treated with intravenous antibiotics while rehabilitating using pylons. The remaining seven transfemoral amputees required surgical intervention and intravenous antibiotics. Five achieved independent ambulation following modification to or replacement of the originally cast prosthesis, averaging 408 days between amputation and commencement of rehabilitation. Two patients have not engaged in rehabilitation. CONCLUSION: RLO delays rehabilitation and has significant financial implications, incurred by prolonged hospitalisation, radiological investigations and prosthetic modifications. RLO should be considered in any case of delayed wound healing or residual limb pain in amputees, as earlier diagnosis may reduce the time to commencement of rehabilitation and subsequent independent ambulation.

Clinical outcomes after closed, staged, and open forefoot amputations.

BACKGROUND: Surgical approaches for forefoot osteomyelitis include amputation with immediate wound closure or resection followed by either staged re-resection and wound closure or local care of the open wound for secondary healing. This study evaluated the effectiveness of closed, staged, and open forefoot amputations in preventing major leg amputation and identified those variables that are associated with successful limb preservation. METHODS: From July 2002 to June 2004, 208 patients with forefoot osteomyelitis or gangrene underwent minor amputation according to a standard treatment algorithm. Wounds with limited cellulitis underwent immediate wound closure (CLOSED), wounds with marginally viable soft tissue underwent open amputation followed by wound closure at 2 to 7 days (STAGED), and wounds with tenosynovitis or extensive necrosis underwent débridement with no attempt at wound closure (OPEN). Patient demographics, need for further operative interventions, time to complete healing, and progression to major amputation were recorded. RESULTS: With four subjects lost to follow-up, 204 patients (98%) (94 CLOSED, 56 STAGED, and 54 OPEN) were monitored to complete healing, major amputation, or death. OPEN amputations had a significantly reduced initial healing rate (37%, P < .001) and a frequent need for repeat operative intervention (43%), although successful limb salvage was ultimately achieved in 70% of the cases. Initial healing in the CLOSED and STAGED amputation groups was similar (71% and 78%, respectively), leading to excellent early limb salvage (86% and 91%). The median time to healing for closed, staged, and open amputations was 1.2, 1.6, and 4.6 months, respectively (P < .001). Follow-up evaluation demonstrated the initial improvements in limb salvage with the CLOSED and STAGED groups were lost, resulting in similar amputation rates among the three groups of 30% to 35% over 36 months. CONCLUSIONS: Although open amputation of extensive forefoot infections frequently requires repeat operative interventions and a prolonged time to complete healing, this approach provides limb salvage rates approaching those observed for less invasive infections amenable to immediate closure. Staged closure offers an improved time to healing without negatively impacting the risk of major limb amputation. Independent of their initial operative approach, these patients frequently progress to early leg amputation.

A blessing in disguise: resolution of tardive dyskinesia with development of cervical myelitis.

Tardive dyskinesia (TD), which is frequently seen in patients treated with dopamine receptor blocking agents, is difficult to manage. We report on a young Chinese man with bipolar disorder who developed TD after haloperidol treatment, involving the trunk, limbs, and orofacial area. TD persisted despite switching to atypical antipsychotic agents and treatment with valproate, benzodiazepines, and tetrabenazine. Resolution only occurred years later when he developed quadriplegia arising from infective myelitis of the cervical cord (C4-5). He had concomitant vertebral osteomyelitis, which was successfully treated with intravenous antibiotics. With intensive rehabilitation, he recovered the use of his limbs, but had no recurrence of TD. We attribute the resolution of orofacial dyskinesias with a cervical lesion to the interconnections between the orofacial area and cervical spine via the trigeminal nucleus (which has fibers descending as far caudally as C6), as well as to resetting of cortical maps.

[Low-frequency pulsed magnetotherapy combined with electrostimulation of biologically active points in the combined treatment of traumatic mandibular osteomyelitis]. / Nizkochastotnaia impul'snaia magnitoterapiia v sochetanii s élektrostimuliatsiei biologicheski aktivnykh tochek v kompleksnom lechenii travmaticheskogo osteomielita nizhnei cheliusti.

The results of treatment are analyzed in 51 patients (35 with exacerbation of chronic traumatic mandibular osteomyelitis and 16 with chronic traumatic mandibular osteomyelitis). Low-intensity pulsed magnetic therapy of the focus in combination with electric stimulation of segmentary bioactive points, synchronized by the patient's pulse, are proposed to be added to the therapeutic complex. Such a modality improved the regional hemodynamics, promoted liquidation of the postoperative edema on days 1-2 after intervention, and sooner than after traditional therapy repaired the energy of the patient's organism.

The "turn-up" plasty: one solution to a complex problem.

This case study presents a patient with severe osteomyelitis of the femur, which did not respond to vigorous antibiotic therapy. Compromised kidney function, malnutrition, and copious drainage from an open wound led the patient and physician to select a seldom used procedure, the "turn up" plasty to treat the problem. This procedure provides a stump for an above-the-knee prosthesis providing the patient with more optimal function than if the femur and lower leg were amputated. The procedure involves removal of the infected femur, foot amputation, knee disarticulation and turning the lower leg up, using the tibia to support the femoral component of a joint replacement. After several months, the patient is wearing a prosthesis, walking without pain, and satisfied with his decision.

Spinal epidural abscess complicating vertebral osteomyelitis: an insidious cause of deteriorating spinal cord function.

Spinal epidural abscess may complicate vertebral osteomyelitis. The purpose of this report is to discuss its course in two patients with sensory/motor and cognitive impairment and to demonstrate the need for its early detection. Delayed detection may lead to spinal cord injury or meningitis. It may also delay functional return and hinder intensive rehabilitation efforts. Two patients are presented.

[The optimization of combined physiotherapy in the system of rehabilitating victims with complicated fractures of the extremities]. / Optimizatsiia kompleksnoi fizioterapii v sisteme reabilitatsii postradavshikh s oslozhnennymi perelomami konechnostei.

The schemes were worked out for optimization of complex physiotherapy in rehabilitation system of patients with complicated fractures of extremities. This work was carried out on the basis of 178 dynamic clinic observations with application of biomechanical and roentgenological methods, as well as methods of mathematical modelling and prognostication. That made it possible to increase the efficiency of rehabilitation programs by 3.2--4.1 times. The article deals with the perspective trends in the development of this problem.

[Psychosocial problems in patients with chronic osteomyelitis]. / Psychosoziale Probleme bei Patienten mit chronischer Osteomyelitis.

52 patients suffering from a chronical bone infection were followed up with a special interest in psychosocial problems. In all cases psychosocial disturbances of different importance were evaluated. Possible causes have to be seen in long time of hospitalisation (average = 304 days), and apparent inadequate enlightenment of patients and in functionally and cosmetically insufficiencies. Conclusions are shown for the management in treatment of chronical bone infections.

[Reconstruction of vascular bed in the affected segment of the leg in patients with defects of the crural bones complicated by chronic osteomyelitis]. / Vosstanovlenie sosudistogo rusla v porazhennom segmente u bolnykh s defektami kostei goleni, oslozhnennymi khronicheskim osteomielitom.

The article analyses the results of medical rehabilitation of 176 patients with defects in the leg bones complicated by chronic osteomyelitis by methods of transosseous osteosynthesis. In average hospitalization terms of 380.8 +/- 15.6 days, medical rehabilitation was achieved in 88.6% of patients. The results of complex clinical and laboratory examination of 46 patients by means of angiographic, radionuclide, and physiological methods confirm gradual correction of the initial regional arterial insufficiency which was combined with anatomical and physiological rehabilitation of the affected leg by the end of treatment. It was established that the high clinical result of the developed methods of transosseous osteosynthesis is based on the formation of a new zone of the vascular channel in the affected limb segment.

[Rehabilitation of invalids with sequelae and late complications of gunshot wound of the locomotor system]. / Reabilitatsiia invalidov s posledstviiami i pozdnimi oslozhneniiami ognestrel'nykh povrezhdenii oporno-dvigatel'noi sistemy.

The authors have generalized their experience in treating 2178 invalids of the Great Patriotic War with consequences of gunshot injuries and diseases of the locomotor system. 49.24% of the patients had chronic gunshot osteomyelitis, 36.38% had diseases of stumps of the extremities, 6.5% had false joints and 7.81% had ulcerated cicatrices and trophic ulcers. The authors give examples of late complications of the consequences of the gunshot injuries, changes in the morbidity structure among the invalids in the recent years, associated diseases and methods of their treatment and prevention.

[Rehabilitation of patients with suppurative osseous complications of gunshot wounds of the shoulder in Ethiopia]. / Reabilitatsiia bol'nykh s gnoino-kostnymi oslozhneniiami ognestrel'nykh ranenii plecha v usloviiakh Efiopii.

The authors have analysed the results of the treatment of 68 patients with pyo-osseous complications of the gunshot wounds of the shoulder which had been repeatedly operated at previous stages. The failures were connected with suppurations of the wounds, faults of the surgical technique and the postoperative management of the patient. All the patients were operated repeatedly at two stages: radical necrosequestrotomy, epidermatoplasty and tendoplasty were performed at stage I and bone autografting with immobilization with an plaster bandage were performed at stage II. The results of the treatment were good in 31 patients, satisfactory in 18 patients and not satisfactory in 6 patients. After tendoplasty the results were good in 12 patients and satisfactory in in 6 patients.

[Chronic gunshot osteomyelitis of the long bones of 40-45 years' duration and its significance for expert testimony]. / Khronicheskii ognestrel'nyi osteomielit dlinnykh kostei 40-45 letne davnosti i ego ékspertnoe znachenie.

The authors have made a clinicoroentgenologic and pathomorphologic comparison of the materials of examination of 81 patients aged 60 to 75 years with exacerbations of chronic gunshot osteomyelitis of the long bones after 40-45 years. The clinicoroentgenologic characteristics of active and slow exacerbations is presented. Four types of changes in the roentgenologic picture have been revealed: destructive, necrotic, corticalitis type, fistulous and mixed. The peculiarity of the manifestations of osteonecrosis in the form of sequesters and two types of crumb-like inclusions and bone reconstruction (with linear separation of the compact bone layer on the inner surface and perifocal osteoporosis) has been pointed out. Besides, some problems of medical labour examination in chronic gunshot osteomyelitis after 40-45 years have been considered.