Surgical Treatment of Non Diabetic Chronic Osteomyelitis Involving the Foot and Ankle Jae-Jung Jeong 1 • Ho-Seong Lee 2 • Sang-Woo Kim 3 • Young-Rak Choi 4 • Jeong-Ho Seo 5 Department of Orthopedic Surgery, The Catholic University of Korea, Daejeon St. Mary’s Hospital 1 , Asan Medical Center , College of Medicine, Ulsan University 2 , Ulsan University Hospital, College of Medicine, Ulsan University 3 CHA Bundang Medial Center, CHA University 4 , Bumin Seoul hospital 5
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Surgical Treatment of Non Diabetic Chronic Osteomyelitis … · 2017-10-18 · Surgical Treatment of Non Diabetic Chronic Osteomyelitis Involving the Foot and Ankle Jae-Jung Jeong
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• MRI for accurate extent, invasion of adjacent joint
forefoot : 1
Midfoot : 1
Distal tibia : 6
Ankle : 3
Calcaneus : 4
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
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
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
CASE I M/41 9yrs ago TA
distal tibia open fx.
>10times I&D , Flap
ESR/CRP : 18/0.44
Culture : pseudomonas
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
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
CONCLUSION
Wide debridement
Dead space control
Selective Joint Arthrodesis
For successful Treatment Of COM
involving foot & ankle
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