RESUMEN
BACKGROUND: Arthrodesis of the ankle is a salvage procedure in case of chronic ankle joint infection. External fixation still is the gold standard. We compared the outcome of external fixator versus intramedullary nailing for arthrodesis of the infected ankle joint. METHODS: All patients with ankle joint infection who received arthrodesis with either external fixator or intramedullary nail between 08/2009 and 09/2017 were retrospectively analyzed. Endpoints were the successful control of infection, osseous fusion, and mobilization with full weightbearing. RESULTS: Seventy-one patients were included. Nineteen patients (27%) suffered reinfection. Patients with intramedullary nailing showed significantly fewer reinfections (p=0.019), achieved full weightbearing significantly more often (p=0.042) and faster and developed significantly fewer complications (p<0.001). Forty-three patients showed bone fusion without significant differences between the groups. CONCLUSIONS: Ankle arthrodesis with intramedullary nailing appears to be a successful alternative to the established procedure of external fixation in cases of chronic ankle joint infection.
Asunto(s)
Articulación del Tobillo/cirugía , Artritis Infecciosa/cirugía , Artrodesis/métodos , Fijadores Externos , Fijadores Internos , Rango del Movimiento Articular/fisiología , Articulación del Tobillo/diagnóstico por imagen , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Soporte de PesoRESUMEN
BACKGROUND: Treatment of chronic osteomyelitis (COM) remains challenging and often results in large bone defects. Dead space management and proper defect filling are essential for successful treatment. Bioactive glass S53P4 (BAG-S53P4) is an anorganic bone graft substitute with antibacterial, osteoconductive, osteostimulative and angiogenic properties. The aim of our study was to analyse the outcome of patients with COM and infected non-unions, whose bone defects were filled with BAG-S53P4. MATERIAL AND METHODS: In this retrospective study (07/13â-â02/16), we analysed all patients with COM and infected non-unions, who obtained BAG-S53P4 after surgical debridement to fill their bone defects. Epidemiological data, pre-, peri- and postoperative characteristics were evaluated. The primary endpoint was the successful control of infection during the follow-up period. Secondary endpoints were the absence of BAG-S53P4-related complications, the time period to full weight bearing as well as to radiologically detectable incorporation of BAG. X-ray examinations were routinely performed 1 month, 3â-â4 months, 6 months and 12 months postoperatively. RESULTS: 50 patients were analysed. Staphylococcus aureus was the most common pathogen involved. On average, 11.1 ± 6.7 cm3 BAG-S53P4 were implanted. Mean follow-up was at 12.3 months. After 6 months, 26/37 (70.3%) and after 12 months, 35/42 (83.3%) of the filled bone defects were healed. X-ray examinations showed a thickened neo-cortex. 40 patients (80%) have achieved full weight bearing after a mean of 4 months. There were no complications at all in 76% of patients. Seven patients suffered reinfection. BAG-associated complications were not seen. CONCLUSIONS: The use of BAG-S53P4 in patients with COM and infected non-unions is promising. Adequate debridement and proper defect filling are necessary. BAG is well tolerated. X-ray examinations showed a thickened neo-cortex. The antibacterial effect is not mediated by antibiotics and is advantageous in times of evolving antibiotic resistance. High quality studies with a longer follow-up are required. TRIAL REGISTRATION: TRN DRKS00011679.
Asunto(s)
Sustitutos de Huesos , Trasplante Óseo/métodos , Fracturas no Consolidadas/cirugía , Vidrio , Traumatismos de la Pierna/cirugía , Osteomielitis/cirugía , Infecciones Estafilocócicas/cirugía , Adulto , Anciano , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Traumatismos de la Pierna/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Recurrencia , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico por imagen , Soporte de PesoRESUMEN
BACKGROUND: The mass panic at the Love Parade 2010 attracted a great deal of public attention in Germany and abroad. The goals of this paper are to summarize the available data on the injured persons and their treatment, and to assess the preparations that should be made for such an eventuality and the acute measures that should be taken if it occurs. METHODS: Patient data from the Duisburg hospitals were subjected to a structured statistical analysis, and all of the measures taken were assessed by qualified evaluators on the basis of questionnaires, a consensus conference, and individual interviews of the clinical coordinators. RESULTS: A total of 250,000 persons took part in the Love Parade; 5600 patient contacts occurred at first-aid posts and 473 patients (mean age, 25.5 years; male:female ratio, 1.4:1) were treated in 12 hospital emergency rooms, 41.7% were admitted to the hospital. Among the admitted patients, 73% stayed in the hospital for less than 24 hours, and 41% signed out against medical advice; 62.2% had a surgical diagnosis, 40.6% a medical one, and 8.0% a psychiatric one (some patients had more than one diagnosis). 47.6% of the surviving patients were classified as mildly injured, 47.8% as moderately injured, and 4.0% as severely injured. Most medical activity was concentrated in three areas: the treatment of drug abuse, the care of many mild and moderate injuries, and Shock Room diagnostic assessment of patients potentially harboring serious injuries. Hospitals were subject to the highest strain 2 to 3 hours after the mass panic, at which time they received up to 20 new patients per hour. CONCLUSION: These data permit a detailed view of the medical care that was provided. In situations of this kind, the main problems can be dealt with through targeted and structured preparation and optimized emergency plans which consider both foreseeable and unforeseeable events. Priority must be given to rapid diagnostic assessment and clinical decision-making; the prerequisites for these are transparent institutional structures and clear assignments of responsibility.