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Chronic diaphyseal osteomyelitis of long bones refractory to conventional therapy — Benefits and risks of reaming of the femoral medullary cavity

  • H. -Ch. Pape
  • H. Zwipp
  • G. Regel
  • H. Maschek
  • H. Tscherne
European Bone And Joint Infection Society Meeting, München, Germany — October 7–9, 1993

Summary

Osteomyelitis of long bones represents a severe complication during fracture healing. If ongoing infection occurs despite reoperation and if antibiotic treatment is of no benefit, reaming of the medullary canal may be beneficial. We investigated the long term follow up (minimum 2 years) of patients submitted to reaming of the medullary canal to evaluate the efficacy of this method. Criteria for successful procedure: no further operative procedure/ antibiotic treatment. 32 patients out of 37 were followed over a 9 year period. Mean incidence of surgical treatment for osteomyelitis prior to reaming: 3.2 operations. Mean duration until reexamination after reaming: 3.7 years. 89% of patients had a full range of motion upon reexamination, in the others further articular injuries were present. 84.3% of patients were working in the same profession as prior to the fracture, 72% were active in sports again, 97% of patients were pain free. One otherwise healthy patient suffering from sclerosing osteitis (Garré) died during reaming of the femur due to bone marrow embolism to the lung. Reaming of the medullary canal has a high rate of curing osteomyelitis even after several previous attempts of surgical revisions and/or antibiotic treatment. The most likely mechanism is based on improvement of local perfusion. During surgery care must be taken not to provoke pulmonary embolization. Intraoperative monitoring by pulmonary artery catheter should performed; reaming should be immediately discontinued, if a rise in pulmonary artery pressure occurs.

Key words

Osteomyelitis, therapy Intramedullary femoral reaming Complications 

Code Méary

4527.0 0755.1 

Ostéomyélite diaphysaire chronique des os longs résistante aux traitements classiques. Bénéfices et risques de l’alésage centro-médullaire fémoral

Résumé

L’ostéomyélite est une complication sévère après une fracture d’un membre. Si l’infection ne cesse pas malgré traitement antibiotique et réintervention, un alésage médullaire peut être proposé. Nous avons étudié avec un recul minimum de 2 ans les patients ayant bénéficié de ce traitement. La durée de l’infection de 32 des 37 patients fut de plus de 9 ans. Les critères de bons résultats furent l’absence de prise d’antibiotiques et d’intervention chirugicale supplémentaire. Les patients avaient bénéficié en moyenne de 3,2 opérations avant la réalisation de l’alésage, et le recul moyen après réalisation de l’alésage fut de 3,7 années. Au contrôle 89 % des patients avaient des amplitudes articulaires libres, 84,3 % des patients avait repris leur ancien travail, 72 % refaisaient du sport, 97 % des patients ne présentaient plus de douleurs. Mais une jeune femme est décédée d’une embolie graisseuse durant l’aléssage. L’alésage du canal médullaire permet de guérir bon nombre d’ostéomyélites même après plusieurs mois de traitement chirurgical et/ou antibiotique. L’explication physiopathologique est une amélioration de la perfusion sanguine osseuse. Néanmoins il faut faire attention au risque d’embolie graisseuse notamment par surveillance de la pression de l’artère pulmonaire.

Mots-clés

Ostéomyélite Traitement Alésage centromédullaire Complications 

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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • H. -Ch. Pape
    • 1
  • H. Zwipp
    • 3
  • G. Regel
    • 1
  • H. Maschek
    • 2
  • H. Tscherne
    • 1
  1. 1.Departments of Trauma SurgeryHannover Medical SchoolHannoverGermany
  2. 2.Institute of PathologyHannover Medical SchoolHannoverGermany
  3. 3.Departments of Trauma SurgeryCarl Gustav Carus UniversityDresdenGermany

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