Συγκριτική μελέτη της μορφομετρίας κατά τον κλασσικό ακτινολογικό έλεγχο (MRX) και της μορφομετρίας με χρήση απορροφησιομετρίας (VFA) στον καθορισμό σπονδυλικών παραμορφώσεων σε οστεοπορωτικούς ασθενείς μετά από κυφοπλαστική.

Σκοπός: H εφαρμογή για πρώτη φορά διεθνώς της μορφομετρίας της σπονδυλικής στήλης με χρήση απορροφησιομετρίας (VFA) σε ασθενείς με κυφοπλαστική. Αναλύονται τα πλεονεκτήματα και μειονεκτήματα της μεθόδου, ελέγχεται η αξιοπιστία της και συγκρίνεται με την μορφομετρία κατά τον κλασσικό ακτινολογικό έλεγχο (ΜRΧ) στην εκτίμηση των σπονδυλικών παραμορφώσεων στους συγκεκριμένους ασθενείς. Υλικά και Μέθοδος: Πραγματοποιήθηκαν μετρήσεις σε 42 ασθενείς με κυφοπλαστική λόγω οστεοπορωτικών σπονδυλικών καταγμάτων και αναλύθηκαν οι σπόνδυλοι από τον T4 μέχρι τον L4 με την VFA και την MRX. Μετρήθηκαν το πρόσθιο (ha), μέσο (hm) και οπίσθιο (hp) ύψος του σπονδυλικού σώματος και προσδιορίσθηκαν οι λόγοι ha/hp και hm/hp. Αναλύθηκαν για την VFA η συμφωνία αποτελεσμάτων του ίδιου παρατηρητή (IOA) και η συμφωνία αποτελεσμάτων μεταξύ ανεξάρτητων παρατηρητών (INA) για τους λόγους ha/hp και hm/hp καθώς και για την μέθοδο Genant σε επίπεδο σπονδύλου, ‘περιοχής της σπονδυλικής στήλης (θωρακική/ΘΜΣΣ ή οσφυϊκή/ΟΜΣΣ), σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’, και σε επίπεδο ‘σπονδύλων με κυφοπλαστική’. Σε κάθε επίπεδο χρησιμοποιήθηκε η μέση τιμή ha/hp και hm/hp. Στη συνέχεια, αναλύσαμε την συμφωνία μεταξύ VFA και MRX στον καθορισμό των λόγων ha/hp και hm/hp καθώς και μετά την διχοτόμηση των λόγων ha/hp περί της τιμής όριο που συνήθως χρησιμοποιείται για τον καθορισμό ενός κατάγματος. Αποτελέσματα: Οι IOA και INA για τους λόγους ha/hp και hm/hp στην VFA ήταν ‘σχεδόν τέλεια’ σε όλα τα επίπεδα (ICC 0.94-0.98). Η εφαρμογή της μεθόδου Genant κατά την VFA ανέδειξε επίσης ‘σχεδόν τέλεια’ INA (ICC=0.833). Η ανάλυση σε επίπεδο σπονδύλου έδειξε ‘σχεδόν τέλεια’ συμφωνία μεταξύ VFA και MRX για τον λόγο ha/hp [intraclass correlation coefficient, ICC=0.85], και ‘ισχυρή συμφωνία’ για τον λόγο hm/hp (ICC=0.78). Για τον λόγο ha/hp η συμφωνία ήταν ‘σχεδόν τέλεια’ τόσο στην ΘΜΣΣ (ICC=0.82) όσο και στην ΟΜΣΣ (ICC=0.87), ενώ για τον λόγο hm/hp η συμφωνία ήταν ‘ισχυρή’ στην ΘΜΣΣ (ICC=0.75) και ‘σχεδόν τέλεια’ στην ΟΜΣΣ (ICC=0.80). Η συμφωνία ήταν εξίσου ‘σχεδόν τέλεια’ σε επίπεδο ‘σπονδύλων με κυφοπλαστική’ (ICC=0.83) όσο και σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’ (ICC=0.80) για τον λόγο ha/hp. Όταν οι λόγοι ha/hp μετατράπηκαν σε κατάγματα (ναι ή όχι κάταγμα) χρησιμοποιώντας διαφορετικές τιμές κατώφλι για την διάγνωση κατάγματος (λόγοι ha/hp 0.75, 0.80 και 0.85) η συμφωνία μεταξύ των μεθόδων ήταν λιγότερο καλή, από μέτρια έως ουσιώδης (κ 0.52-0.63 στην ΟΜΣΣ και 0.53-0.66 στην ΘΜΣΣ). Χρησιμοποιώντας την κατάταξη Genant οι διαφορές στην ταξινόμηση των σπονδύλων ήταν περισσότερο προς την κατεύθυνση της MRX με 32 αναγνωρισμένα κατάγματα μόνο από την MRX και μόνο 5 μόνο από την VFA. Στη μελέτη αυτή, με επιπολασμό σφηνοειδών σπονδυλικών καταγμάτων 9.3%, οι δείκτες ακρίβειας sensitivity, specificity, positive predictive value (PPV) και negative predictive value (NPV) υπολογίστηκαν σε 0.522, 0.97, 0.87 και 0.92 αντίστοιχα. Συμπεράσματα: Η εφαρμογή της VFA σε ασθενείς με κυφοπλαστική έχει υψηλή επαναληψιμότητα και αναπαραγωγιμότητα. Η συμφωνία μεταξύ VFA και MRX στην εκτίμηση των λόγων ha/hp και hm/hm ήταν από ‘ισχυρή’ έως ‘σχεδόν τέλεια’ ανάλογα με το επίπεδο εξέτασης. Η συμφωνία στην αναγνώριση των σπονδυλικών καταγμάτων ήταν μέτρια. Οι διαφορές ήταν περισσότερο προς την κατεύθυνση της MRX. Η υψηλή τιμή του δείκτη NPV της VFA στους ασθενείς με κυφοπλαστική, δείχνει ότι η μέθοδος θα μπορούσε να χρησιμοποιηθεί για τον εντοπισμό αυτών που χρήζουν περαιτέρω ακτινολογικού ελέγχου.Objective: To apply, for the first time internationally, the method of Vertebral Fracture Assessment (VFA) to patients treated with kyphoplasty for osteoporotic vertebral fractures. To analyze the advantages and disadvantages of VFA, check its reliability and compare VFA with morphometric x-ray absorptiometry (MRX) in the assessment of vertebral deformities to the particular patients. Patients and Methods: Forty-two patients treated with kyphoplasty underwent VFA and MRX. Anterior (ha), middle (hm) and posterior (hp) heights of the vertebral bodies were measured and the ratios ha/hp and hm/hp were calculated. Initially, we estimated the intraobserver agreement (IOA) and the interobserver agreement (INA) for the VFA using ha/hp and hm/hp ratios as well as the Genant method. The relative intra-class correlation coefficient (ICC) was calculated on the “vertebral” level, on the “region” level (thoracic or lumbar), on the “vertebrae with kyphoplasty” level and on the “adjacent to the kyphoplasty vertebrae” level using the mean value of ha/hp and hm/hm on each level. Then, we analyzed the agreement between VFA and MRX on measuring ha/hm and hm/hp ratios and after the ratio ha/hp was dichotomized above or below cut-off levels that are commonly used to identify fractures. Results: Intra- and interobserver agreement for the ratios ha/hp and hm/hp on VFA was “almost perfect” on all levels (ICC 0.94-0.98). Application of the Genant’s cut-off ratios for assessing the vertebrae during VFA also showed “almost perfect” interobserver agreement (κ = 0.833). Analysis on a “vertebral” level resulted in “almost perfect” agreement between VFA and MRX using the ratio ha/hp (ICC=0.85) and in “strong agreement” using the ratio hm/hp (ICC=0.78). Using the ratio ha/hp agreement was “almost perfect” on the thoracic (ICC=O.82) and lumbar region (ICC=0.87) while for the ratio hm/hp agreement was “strong” on the thoracic (ICC=0.75) and “almost perfect” on the lumbar region (ICC=0.80) of the spine. Agreement was also “almost perfect on the “vertebrae with kyphoplasty” level (ICC=0.83) as well as on the “adjacent to the kyphoplasty vertebrae” level (ICC=0.80) for the ratio ha/hp. If the ratios ha/hp were translated into fractures (yes vs no) using different cut off levels for a fracture (AP-ratios 0.75, 0.80 or 0.85) between-method agreement became moderate to substantial (κ 0.52-0.63 on the lumbar and 0.53-0.66 on the thoracic spine). Differences using the Genant classification were mostly in the direction of MRX with 32 identified fractures only on MRX and 5 only in VFA. In this study with a prevalence of 9.3% of vertebral fractures, the sensitivity, specificity, positive predictive value (PPV) και negative predictive value (NPV) were 0.522, 0.97, 0.87 και 0.92 respectively. Conclusion: Application of VFA to patients with kyphoplasty has high repeatability and reproducibility. Agreement between VFA and MRX on assessing vertebral deformities using the ratios ha/hp and hm/hp was “strong” to “almost perfect” depending on the level examined. Beyond the agreement between VFA and MRX in assessing vertebral deformities, expressed as ha/hp and hm/hp ratios, applying the Genant method resulted in less agreement between methods. Differences were mostly on the direction of MRX and this is in line with the literature reporting smaller sensitivity and specificity of the VFA using the Genant method in identifying mild vertebral fractures in comparison to the MRX. The high value, though, of NPV for the VFA on patients with kyphoplasty indicates that the method could be used to select patients for further evaluation by X-ray when assessing vertebral fractures as a sign of bone failure

Comparative study between morphometric x-ray absorptiometry (MRX) and vertebral fracture assessment (VFA) in defining vertebral fractures in osteoporotic patients with kyphoplasty

Objective: To apply, for the first time internationally, the method of Vertebral Fracture Assessment (VFA) to patients treated with kyphoplasty for osteoporotic vertebral fractures. To analyze the advantages and disadvantages of VFA, check its reliability and compare VFA with morphometric x-ray absorptiometry (MRX) in the assessment of vertebral deformities to the particular patients.Patients and Methods: Forty-two patients treated with kyphoplasty underwent VFA and MRX. Anterior (ha), middle (hm) and posterior (hp) heights of the vertebral bodies were measured and the ratios ha/hp and hm/hp were calculated. Initially, we estimated the intraobserver agreement (IOA) and the interobserver agreement (INA) for the VFA using ha/hp and hm/hp ratios as well as the Genant method. The relative intra-class correlation coefficient (ICC) was calculated on the “vertebral” level, on the “region” level (thoracic or lumbar), on the “vertebrae with kyphoplasty” level and on the “adjacent to the kyphoplasty vertebrae” level using the mean value of ha/hp and hm/hm on each level. Then, we analyzed the agreement between VFA and MRX on measuring ha/hm and hm/hp ratios and after the ratio ha/hp was dichotomized above or below cut-off levels that are commonly used to identify fractures. Results: Intra- and interobserver agreement for the ratios ha/hp and hm/hp on VFA was “almost perfect” on all levels (ICC 0.94-0.98). Application of the Genant’s cut-off ratios for assessing the vertebrae during VFA also showed “almost perfect” interobserver agreement (κ = 0.833). Analysis on a “vertebral” level resulted in “almost perfect” agreement between VFA and MRX using the ratio ha/hp (ICC=0.85) and in “strong agreement” using the ratio hm/hp (ICC=0.78). Using the ratio ha/hp agreement was “almost perfect” on the thoracic (ICC=O.82) and lumbar region (ICC=0.87) while for the ratio hm/hp agreement was “strong” on the thoracic (ICC=0.75) and “almost perfect” on the lumbar region (ICC=0.80) of the spine. Agreement was also “almost perfect on the “vertebrae with kyphoplasty” level (ICC=0.83) as well as on the “adjacent to the kyphoplasty vertebrae” level (ICC=0.80) for the ratio ha/hp. If the ratios ha/hp were translated into fractures (yes vs no) using different cut off levels for a fracture (AP-ratios 0.75, 0.80 or 0.85) between-method agreement became moderate to substantial (κ 0.52-0.63 on the lumbar and 0.53-0.66 on the thoracic spine). Differences using the Genant classification were mostly in the direction of MRX with 32 identified fractures only on MRX and 5 only in VFA. In this study with a prevalence of 9.3% of vertebral fractures, the sensitivity, specificity, positive predictive value (PPV) και negative predictive value (NPV) were 0.522, 0.97, 0.87 και 0.92 respectively. Conclusion: Application of VFA to patients with kyphoplasty has high repeatability and reproducibility. Agreement between VFA and MRX on assessing vertebral deformities using the ratios ha/hp and hm/hp was “strong” to “almost perfect” depending on the level examined. Beyond the agreement between VFA and MRX in assessing vertebral deformities, expressed as ha/hp and hm/hp ratios, applying the Genant method resulted in less agreement between methods. Differences were mostly on the direction of MRX and this is in line with the literature reporting smaller sensitivity and specificity of the VFA using the Genant method in identifying mild vertebral fractures in comparison to the MRX. The high value, though, of NPV for the VFA on patients with kyphoplasty indicates that the method could be used to select patients for further evaluation by X-ray when assessing vertebral fractures as a sign of bone failure.Σκοπός: H εφαρμογή για πρώτη φορά διεθνώς της μορφομετρίας της σπονδυλικής στήλης με χρήση απορροφησιομετρίας (VFA) σε ασθενείς με κυφοπλαστική. Αναλύονται τα πλεονεκτήματα και μειονεκτήματα της μεθόδου, ελέγχεται η αξιοπιστία της και συγκρίνεται με την μορφομετρία κατά τον κλασσικό ακτινολογικό έλεγχο (ΜRΧ) στην εκτίμηση των σπονδυλικών παραμορφώσεων στους συγκεκριμένους ασθενείς.Υλικά και Μέθοδος: Πραγματοποιήθηκαν μετρήσεις σε 42 ασθενείς με κυφοπλαστική λόγω οστεοπορωτικών σπονδυλικών καταγμάτων και αναλύθηκαν οι σπόνδυλοι από τον T4 μέχρι τον L4 με την VFA και την MRX. Μετρήθηκαν το πρόσθιο (ha), μέσο (hm) και οπίσθιο (hp) ύψος του σπονδυλικού σώματος και προσδιορίσθηκαν οι λόγοι ha/hp και hm/hp. Αναλύθηκαν για την VFA η συμφωνία αποτελεσμάτων του ίδιου παρατηρητή (IOA) και η συμφωνία αποτελεσμάτων μεταξύ ανεξάρτητων παρατηρητών (INA) για τους λόγους ha/hp και hm/hp καθώς και για την μέθοδο Genant σε επίπεδο σπονδύλου, ‘περιοχής της σπονδυλικής στήλης (θωρακική/ΘΜΣΣ ή οσφυϊκή/ΟΜΣΣ), σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’, και σε επίπεδο ‘σπονδύλων με κυφοπλαστική’. Σε κάθε επίπεδο χρησιμοποιήθηκε η μέση τιμή ha/hp και hm/hp. Στη συνέχεια, αναλύσαμε την συμφωνία μεταξύ VFA και MRX στον καθορισμό των λόγων ha/hp και hm/hp καθώς και μετά την διχοτόμηση των λόγων ha/hp περί της τιμής όριο που συνήθως χρησιμοποιείται για τον καθορισμό ενός κατάγματος. Αποτελέσματα: Οι IOA και INA για τους λόγους ha/hp και hm/hp στην VFA ήταν ‘σχεδόν τέλεια’ σε όλα τα επίπεδα (ICC 0.94-0.98). Η εφαρμογή της μεθόδου Genant κατά την VFA ανέδειξε επίσης ‘σχεδόν τέλεια’ INA (ICC=0.833). Η ανάλυση σε επίπεδο σπονδύλου έδειξε ‘σχεδόν τέλεια’ συμφωνία μεταξύ VFA και MRX για τον λόγο ha/hp [intraclass correlation coefficient, ICC=0.85], και ‘ισχυρή συμφωνία’ για τον λόγο hm/hp (ICC=0.78). Για τον λόγο ha/hp η συμφωνία ήταν ‘σχεδόν τέλεια’ τόσο στην ΘΜΣΣ (ICC=0.82) όσο και στην ΟΜΣΣ (ICC=0.87), ενώ για τον λόγο hm/hp η συμφωνία ήταν ‘ισχυρή’ στην ΘΜΣΣ (ICC=0.75) και ‘σχεδόν τέλεια’ στην ΟΜΣΣ (ICC=0.80). Η συμφωνία ήταν εξίσου ‘σχεδόν τέλεια’ σε επίπεδο ‘σπονδύλων με κυφοπλαστική’ (ICC=0.83) όσο και σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’ (ICC=0.80) για τον λόγο ha/hp. Όταν οι λόγοι ha/hp μετατράπηκαν σε κατάγματα (ναι ή όχι κάταγμα) χρησιμοποιώντας διαφορετικές τιμές κατώφλι για την διάγνωση κατάγματος (λόγοι ha/hp 0.75, 0.80 και 0.85) η συμφωνία μεταξύ των μεθόδων ήταν λιγότερο καλή, από μέτρια έως ουσιώδης (κ 0.52-0.63 στην ΟΜΣΣ και 0.53-0.66 στην ΘΜΣΣ). Χρησιμοποιώντας την κατάταξη Genant οι διαφορές στην ταξινόμηση των σπονδύλων ήταν περισσότερο προς την κατεύθυνση της MRX με 32 αναγνωρισμένα κατάγματα μόνο από την MRX και μόνο 5 μόνο από την VFA. Στη μελέτη αυτή, με επιπολασμό σφηνοειδών σπονδυλικών καταγμάτων 9.3%, οι δείκτες ακρίβειας sensitivity, specificity, positive predictive value (PPV) και negative predictive value (NPV) υπολογίστηκαν σε 0.522, 0.97, 0.87 και 0.92 αντίστοιχα. Συμπεράσματα: Η εφαρμογή της VFA σε ασθενείς με κυφοπλαστική έχει υψηλή επαναληψιμότητα και αναπαραγωγιμότητα. Η συμφωνία μεταξύ VFA και MRX στην εκτίμηση των λόγων ha/hp και hm/hm ήταν από ‘ισχυρή’ έως ‘σχεδόν τέλεια’ ανάλογα με το επίπεδο εξέτασης. Η συμφωνία στην αναγνώριση των σπονδυλικών καταγμάτων ήταν μέτρια. Οι διαφορές ήταν περισσότερο προς την κατεύθυνση της MRX. Η υψηλή τιμή του δείκτη NPV της VFA στους ασθενείς με κυφοπλαστική, δείχνει ότι η μέθοδος θα μπορούσε να χρησιμοποιηθεί για τον εντοπισμό αυτών που χρήζουν περαιτέρω ακτινολογικού ελέγχου

Augmented debridement for implant related chronic osteomyelitis with an absorbable, gentamycin loaded calcium sulfate/hydroxyapatite biocomposite

We report outcomes from 52 patients with chronic osteomyelitis from implant infection treated with a single stage protocol including debridement augmented with application of CERAMENT™/G biocomposite after resection of Cierny-Mader (C-M) stage III and IV chronic osteomyelitis. Mean age was 53 years with a mean follow up of 17 months. Infection was eradicated in 48 (92.3%) patients. There were four (7.7%) recurrences. Eighteen patients (35%) had a flap. Staphylococci (51%) and Enterococci (15%) were the commonest microorganisms. Local antibiotic augmentation (CERAMENT™/G biocomposite) with dead space management is effective in the treatment of implant related chronic osteomyelitis

Augmented debridement for implant related chronic osteomyelitis with an absorbable, gentamycin loaded calcium sulfate/hydroxyapatite biocomposite

We report outcomes from 52 patients with chronic osteomyelitis from implant infection treated with a single stage protocol including debridement augmented with application of CERAMENT™/G biocomposite after resection of Cierny-Mader (C-M) stage III and IV chronic osteomyelitis. Mean age was 53 years with a mean follow up of 17 months. Infection was eradicated in 48 (92.3%) patients. There were four (7.7%) recurrences. Eighteen patients (35%) had a flap. Staphylococci (51%) and Enterococci (15%) were the commonest microorganisms. Local antibiotic augmentation (CERAMENT™/G biocomposite) with dead space management is effective in the treatment of implant related chronic osteomyelitis

Conversion of Failed Hip Hemiarthroplasty to Low Friction Arthroplasty (LFA)

Purpose: We aimed to study clinical and radiological outcomes of conversion from hemiarthroplasty to Charnley hip replacement (CHR) with a particular concern over reported increased dislocation rate and literature review. Conversion of hip hemiarthroplasty to total hip replacement (THR) is a procedure reported to have high rates of complications. In the literature, there is no specific study on small head conversion. The purpose of this study was to evaluate the conversion of failed hip hemiarthroplasty to CHR with the use of modern implants. Methods: The study included 42 patients, who underwent the above procedure. The operations were carried out using a modern Charnley-type THR with a 22-mm diameter of femoral head and a trans-trochanteric approach. The mean follow-up was 75.7 months (range 25–171). Radiographs from the last follow up were evaluated for loosening and other reasons of failure. Clinical outcome was assessed using postoperative pain, function scores, complications and implant survivorship as well as radiological evaluation. Charnley’s modified pain and mobility scoring system were used for clinical and Hodgkinson and Harris’ criteria were used for radiological assessment. Results: Functionally, all of the patients showed improvement. Mean improvement in the pain level was by average of 2.4. On mobility assessment, 38 patients (90.4%) improved. Three patients (7.1%) had recurrent infections and three (4.8%) cases were treated with revision surgery and pseudarthrosis. Further complications occurred in 19.1%, not requiring operative treatment. On radiological evaluation, one (2.4%) case showed cup demarcation without bone loss, two (4.8%) cup migration, and one (2.4%) stem demarcation. Kaplan Meier survival analysis showed a survival of 90% at 96 months of follow up (95% CI (confidence interval), 60–90). Conclusion: Larger head might not be the answer to decrease the dislocation rate. Complication rates during revision of hip hemiarthroplasty to modern CHR with 22.225-mm head diameter were comparable to first-time THR revision despite having a smaller head

Distal metatarsal coalition: A rare case report

Introduction: Metatarsal coalition is an extremely rare condition. We report the second documented case of 4th and 5th distal metatarsal coalition in the literature. Presentation of case: An eight-year-old girl was referred to an orthopaedic clinic with a four-month history of forefoot pain and swelling on the plantar aspect of the right little toe. Radiograph and clinical examination confirmed distal metatarsal coalition between the 4th and 5th metatarsals. Following a period of conservative treatment, excision was eventually performed due to worsening symptoms. Patient re-attended two years later with a recurrence of the coalition confirmed by computed tomography (CT) scan. The case was discussed at a tertiary paediatric orthopaedic insititution. Decision was made to manage patient conservatively with insole and physiotherapy until skeletal maturity. A year later, patient’s symptoms did not worsen, and her foot displayed no evidence of change in the arch and shape. Discussion: The timing of ossification of coalition varies from one anatomical site to another. Surgery when performed before ossification is complete runs the risk of recurrence. Conclusion: Our case report illustrates the importance of restoring normal weight bearing dynamics and pain relief when managing metatarsal coalition, or synostosis in skeletally immature patients. We recommend persevering with conservative treatment, with operative treatment reserved only as a later option, and ideally, until skeletal maturity is achieved

Evolution of the infirmary during the medieval; social, economic and religious status

The infirmary as we know it nowadays does not exist during the Middle Ages, but the various precursors of the modern hospital evolved as a result of interactions between East and West. There is hardly any research that describes the influence of the Medieval social, economic and religious status in the West and East on the infirmary. The present work aims on the development of the infirmary at Medieval time or Middle age with a short insight to previous evolution. The research was conducted in different stages. Textbooks and lectures from the Department of History and Methodology of Science of the University of Athens (UoA) and other relevant departments of Greek universities were consulted. In order to collect relevant information, the keywords “infirmary”, “medical theory”, “ antiquity”, “medieval”, “hospital”, “West” and “Asklipieion” were searched on Google, PubMed and Wikipedia. The infirmaries in the East were not simple buildings but rather a complex of clinical, teaching/education and praying areas. These institutions formed a model to the later European infirmaries. Many of the physicians of the East were ahead of their times. It is obvious that during the Middle Ages religion is a keystone for the function of the infirmary. Both in the East as in the West Christianity and Islam provide the ethical base and funding for the function and the development of new hospitals. Despite the conflict between these two worlds, their societies interacted and influenced medicine and the infirmary as an institution. It is the result of a long process of development of the relations between people, societies or even religions and the way humanity perceive its nature and the future. © 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved

Single stage treatment of diabetic calcaneal osteomyelitis with an absorbable gentamicin-loaded calcium sulphate/hydroxyapatite biocomposite: The Silo technique

Background: Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. Methods: The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Twelve consecutive diabetic patients with heel ulcers and calcaneal osteomyelitis were treated with the above method. All had comorbidities (Cierny–Mader (C–M) Class B hosts). The mean age was 68 years (range 50–85). A retrospective review of radiographs and electronic medical records was conducted. Results: Patients were followed up until clinical cure of the ulcer for a mean of 16 weeks (range 12–18). Infection was eradicated in all 12 patients with a single stage procedure following a bone preserving technique. One patient required a subsequent flap operation and six vacuum-assisted closure (V.A.C.). There was also one case of prolonged wound leakage and no calcaneal fractures. Conclusions: The Silo technique is an effective method of local delivery of antibiotics and can be effectively implemented into the single-stage treatment of calcaneal osteomyelitis offering increased bone preservation and local delivery of antibiotic, decreasing the need for a major amputation