Detaillierte Beitrags-Information
| Beitragstitel | Bone crushing in infected pseudarthroses- An extraordinary way to treat osteomyelitis caused by resistant bacteria |
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| Beitragscode | P088 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Introduction: Osteomyelitis with multi-resistant bacteria in non-union following fracture treated with osteosynthesis requires a complete removal of infected sequestrum and dead bone. For consecutive bone defects it is frequently necessary to bridge with a fixateur externe. The treatment is not only challenging due to reduced bone stock but also characterised by decreased bioavailability of antibiotics. Case Report (Methods/Results): We report a two-step-surgery approach in order to preserve the bone stock by using autologous cancellous bone in a bacterial infected non-union for subsequently leg length reconstruction. The 24-year-old patient was admitted to our department with persistent wound secretion and subsequent osteomyelitis on the right femur 3 years after initial surgery and several revisions and several different antibiotic therapies. Biopsy revealed Methicillin-resistant (MRSA) and borderline Oxacillin-resistant Staphylococcus aureus (BORSA). First the Ilizarov-Ring-Fixateur was removed and a vigorous debridement was performed by refreshing the pseudarthrosis, removing of sequestrum and dead bone. Finally we implanted an AO Fixateur externe . The AO Fixateur externe was removed after ten weeks of antibiotic treatment and an antibiotic-free window of 5 weeks. The bone defect was stabilised by a long Gamma Trochanteric Nail (Stryker, UK). A wide resection of the fragments was performed and the resected fragments were crushed and placed beside the nail to bridge the defect zone. Surprisingly the Biopsies of both bone ends revealed same germs as before. So we established antibiotics for 6 month more and frequent radiographic and clinical controls showed a remodeling of the femur during a period of 3 years and no signs of infection. Subsequently we restored leg length of 4 cm by implanting a fully implantable motorized lengthening nail (Fitbone, Wittenstein; Ingersheim, Germany) and attain full weight bearing. No further germ could be revealed. Conclusion: In this case we could use infected dead autologous bone by crushing them and placing beside the nail. Crushed Bone could improve bioavailability of antibiotics when dealing with multi-resistant bacteria in non-union healed fracture side. Furthermore, this approach was able to provide new bone formation in a limb resulting in full weight bearing. |