Surgical Treatment of Non Diabetic Chronic Osteomyelitis … · 2017-10-18 · Surgical Treatment...
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Surgical Treatment of Non Diabetic
Chronic Osteomyelitis Involving the
Foot and Ankle
Jae-Jung Jeong1 • Ho-Seong Lee2 • Sang-Woo Kim3 • Young-Rak Choi4 • Jeong-Ho Seo5
Department of Orthopedic Surgery,
The Catholic University of Korea, Daejeon St. Mary’s Hospital1, Asan Medical Center , College of Medicine, Ulsan University2,
Ulsan University Hospital, College of Medicine, Ulsan University3
CHA Bundang Medial Center, CHA University4,
Bumin Seoul hospital5
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Surgical Treatment of Non Diabetic
Chronic Osteomyelitis Involving the
Foot and Ankle
Jae-Jung Jeong1 • Ho-Seong Lee2 • Sang-Woo Kim3 • Young-Rak Choi4 • Jeong-Ho Seo5
My disclosure is in the Final AOFAS Program Book.
I have no potential conflicts with this presentation.
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Chronic Osteomyelitis of Foot
• Foot : unique environment for development of infections
• The foot’s environment is modified by footwear, trauma,
systemic illness, and poor soft tissue coverage
• Each of these factors : susceptibility of foot to infection
• Most Common cause in Foot : Diabetic ulcer
• Non diabetic foot infection : open fracture, after internal
fixation, puncture wound
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Purpose
To evaluate the clinical characteristics
of COM involving the foot & ankle
To analyze the treatment outcomes following
debridement, dead space control, and
arthrodesis based on invasion of adjacent joint
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MATERIALS
• Sep. 2004 - Mar. 2007
• 15 patients treated for COM in Foot & ankle
- F/U > 24m, M : F = 10 : 5
- Exclusion : immune compromised, DM
- No vascular problem
• Age : Mean 46.7yrs (25 – 72yrs)
• All pts. referred from other hospital
• Period of Tx. for COM : Mean 3.07yrs (6 -13yr)
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Preoperative evaluation • ESR/CRP : 53.56 (2-120) / 2.86 (0.1-11.86) at OPD visit
• MRI for accurate extent, invasion of adjacent joint
forefoot : 1
Midfoot : 1
Distal tibia : 6
Ankle : 3
Calcaneus : 4
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Surgical Technique ① 1st stage : Extensive margianl excision - until normal tissue, synovectomy & joint debridement - Dead space control : antibiotic-loaded cemet spacer ② 2nd stage : Arthrodesis with BG
Antibiotics mixed cement : 8 cases Bone graft : 10 cases curettage only : 2 cases (TBc of distal tibia, cuboid) cementing only : 1case (distal tibia) partial calcanectomy : 1case
Arthrodesis : 5cases - ankle fusion : 2cases - subtalar fusion : 1case - ankle & subtalar fusion: 1 - TMT fusion : 1case
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Results
Cause Pathogen Fracture : 10 - open fx. : 5 - post. OR/IF : 5 Post. Arthroscopy : 1 Post. Flap surgery :1 Punctuating wound : 1 Recurred AOM : 1 Hematogeous : 1(TBc)
MRSA : 4
Pseudomonas : 4
MSSA, Enterobactor,
M. tuberculosis : 1
Burkholderia, anaerobe : 1
No growth : 1
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Results
• Average of 2 surgeries (1- 3)
• Hospitalized for a mean period: 39.1 day(14-116)
• Keep cement spacer : mean 27day(14-67)
• 14/15pts : no recurrence
• 1 pt : iatrogenic septic arthritis : BKA
• Mean ESR/CRP : 14.7/0.13 at final F/U
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CASE I M/41 9yrs ago TA
distal tibia open fx.
>10times I&D , Flap
ESR/CRP : 18/0.44
Culture : pseudomonas
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CASE II M/56 3month ago
ankle open Fx. – D/L
>10 times debridement
pus discharge, medial
soft tissue defect
AVN of talus
ESR/CRP : 120/3.61
Culture : MRSA
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SUMMARY
• M/C cause : fractures
• Extrinsic cause > intrinsic cause
• M/C pathogen: MRSA, pseudomonas
• Good result after staged operation
(wide debridement + dead space control)
• Check the involvement of adjacent Joint
selective joint arthrodesis
Chracteristics Of COM involving foot & ankle
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CONCLUSION
Wide debridement
Dead space control
Selective Joint Arthrodesis
For successful Treatment Of COM
involving foot & ankle
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