Background: Subacute hematogenous osteomyelitis is a rare disease and difficult to diagnose. Hematogenous osteomyelitis is an infection caused by bacterial seeding from the blood. Acute hematogenous osteomyelitis is characterized by an acute infection of the bone caused by the seeding of the bacteria within the bone from a remote source.\r\n', u"Objectives: The study had two purposes: (1) Remark of Clinical and Xray syndrome of Subacute hematogenous osteomyelitis, and (2) Evaluation of the surgical results. Subjects and method:We operated on 42 patients with Subacute hematogenous osteomyelitis during 18 years period ( from 1984, October to 2005 December). Included 11 female, 31 male at the age from 4 to 12 years old. A rontgenographic classification was described by Gledhill & Roberts. The surgical debridement and irrigated with the antibiotic. Results: The patient's temperature is mildly elevated or normal, the pain isn't remarked. The WBC is normal. The cultures obtained by biopsy are positive in 8/42 patients. The lesions of type 1 in (88.1 % and type 2 in 11.9%. The follow - up: Good in 61.7%,Fair in 32.4%, Poor in 5.9%. Conclusions: The diagnosis and treatment are usually delayed, sometimes must be established by an open biopsy and cultures. Treatment with curettage of the lesion and administration irrigated with the solution antibiotics.\r\n", u'
Osteomyelitis/ pathology ; surgery

OBJECTIVETo explore clinical effects of Ilizarov technique at stage I for repairing tibial post-traumatic osteomyelitis with bone and skin defect.

METHODSFrom June 2010 to December 2013,44 patients with tibial post-traumatic osteomyelitis with bone and skin defect were treated with Ilizarov technique at stage I . Among them, there were 35 males and 9 females aged from 18 to 70 years old with an average of 42.5 years old. Bone defect ranged from 4 to 16 cm, skin defect ranged from 3 cm x 4 cm to 5 cm x 16 cm. The operation was performed debridement thoroughly, removed inflammatory bone section, osteotomy invasively, install circular external fixator by Ilizarow technique; screw nut were rotated at 1 week after operation, and prolonged 0.5 to 1.0 mm everyday. Wound surface, new born callus and bone healing were observed to evaluate clinical effects.

RESULTSAll patients were followed up from 11 to 36 months with an average of 18.5 months. Bone defect after osteotomy was from 6 to 22 cm with an average of 11.5 cm; the time of wound healing time ranged from 21 to 79 d with an average of 38 d; bone defect healing time was from 8 to 15 months with an average of 12.5 months. All patients were cured, no recurrent infection, refracture and shorten of calf deformity were occurred.

CONCLUSIONRepairing tibial post-traumatic osteomyelitis with bone and skin defect by llizarov technique at stage I has advantages of less trauma, low inflammatory recurrence rate, could avoid multiple complex operation, and receive definite curative effect.

Adolescent ; Adult ; Aged ; Female ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Osteotomy ; Tibia ; surgery

OBJECTIVETo discuss the clinical effects and superiority of applying external fixation and bone transport to treat osteomyelitis and bone defect of femoral bone.

METHODSFrom August 2008 to December 2013,16 patients with osteomyelitis and bone defect of femoral bone were treated including 11 males and 5 females with an average age of 42 years old ranging from 13 to 62 years old. The average course of disease was 18 months ranging from 2 months to 4.5 years, and the average length of bone defect was 7.8 cm ranging from 4.5 to 15 cm. The bone defect of all cases were treated by external fixation and bone transport, the bone transport began at 1 week after operation, 1 mm per day and 4 times per day.

RESULTSAll patients were followed up for 10 to 36 months (means 22.5 months). One patient did not cooperate with treatment leads to the failure, then took the amputation. The remaining 15 cases of osteomyelitis were under control, including 12 cases of bone transport achieved one stage bone union, 3 cases achieved bone union via bone graft from iliac bone. The bone union time was 5 to 13 months(means 7.9 months). Thirteen patients almost obtained the same length of two lower extremities,2 patients had shortening of 1.5 to 2 cm. The time of moving the external fixation was from 6 to 16 months (means 9.3 months).

CONCLUSIONApplication of external fixation and bone transport is an effective method in treating the osteomyelitis and bone defect that can control the infection, eradicate wounds, and be the equalization of limb length.

Adolescent ; Adult ; Bone Transplantation ; External Fixators ; Female ; Femur ; surgery ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery

Fistula ; complications ; surgery ; Humans ; Male ; Maxilla ; pathology ; Middle Aged ; Osteomyelitis ; complications ; surgery

OBJECTIVETo investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.

METHODSFrom March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.

RESULTSThe average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.

CONCLUSIONWhen treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.

Adult ; Chronic Disease ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Reconstructive Surgical Procedures ; methods

BACKGROUND: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Treatment failure and consequent lethal outcomes are very common. The aim of this study was to evaluate titanium plate fixation as a treatment for sternal dehiscence following major cardiac surgery. MATERIALS AND METHODS: Between 2010 and 2012, 17 patients underwent sternal reconstruction using horizontal titanium plating for the treatment of post-cardiac-surgery sternal dehiscence. The plates were cut and shaped, and then were fixed to corresponding costal segments using 2-3 titanium screws per each side. RESULTS: The median age of our patients was 66 years (range, 50 to 78 years) and 9 were female. Indications for sternal reconstruction included aseptic sternal dehiscence in 3 patients and osteomyelitis in 14 patients including 6 patients who were diagnosed with mediastinitis. During the operation, sternal resection and autologous flap interposition were combined in 11 patients. One patient died due to sepsis. Two patients required additional soft tissue wound revisions. Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications. The postoperative course was uncomplicated in the other 13 patients. CONCLUSION: Titanium plate fixation that combines appropriate debridement and flap interposition is very effective for the treatment of sternal dehiscence following major cardiac surgery.
Debridement ; Female ; Humans ; Mediastinitis ; Osteomyelitis ; Reoperation ; Sepsis ; Sternum ; Thoracic Surgery ; Titanium ; Treatment Failure ; Wound Infection

Adult ; Dermatologic Surgical Procedures ; Drainage ; methods ; Humans ; Male ; Osteomyelitis ; therapy ; Skin ; injuries ; Thigh ; surgery

OBJECTIVETo explore the therapeutic effects of VSD combined with fascio-cutaneous flap transferation staging operation for the treatment of post-traumatic osteomyelitis.

METHODSFrom December 2007 to December 2009, 14 patients were treated with the technology of VSD combined with fascio-cutaneous flap transferation staging operatinon. Nine patients were males and 5 patients were females, and mean age was 36 years. All the patients were postoperative wound infection. Osteomyelitis of the tibia was in 9 cases, calcaneus in 3 cases, femur in 1 case, radius and ulna in 1 case; infection of time were from 2 to 96 weeks, an average time of 32 weeks.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 36 months, with an average of 19.2 months. All the patients were treated with debridement and VSD for 1 to 3 times, with an average of 1.57 times. The wounds of 13 cases healed well after flaps transferation, but of 1 case leakaged and healed after 3 weeks with the therapy of drainaging and changing dressings. Due to delayed healing or defects of bone, 8 patients had autologous bone grafted on the second stage. All wounds and fractures healed without recurrence of postoperative infection.

CONCLUSIONVSD combined with flap transferation is an effective treatment of post-traumatic osteomyelitis, which can shorten the treatment time and have better security and reliability than traditional methods.

Adult ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Surgical Flaps ; Wounds and Injuries ; complications

Surgery, Department of Dankook University Hospital from January 2002. to Augast 2005. who were diagnosed histopathologically with postoperative malignant tumor, osteomyelitis, and bone infiltrative benign disease. Preoperative X-ray, CT, bone scan were taken and were compared with histopathologic finding. Also to compare specificty of each lesion in bone scan, bone density was measured to compare. The results were as follows.1. Among the 25 cases of oral malignant tumor of bony invasion, a positive diagnosis associated with histopathologic evaluation, 22 cases(88%) in bone scan, 14 cases(56%) in CT image, and 10 cases40%) in simple X-ray.2. Among the 31 cases of osteomyelitis, a positive diagnosis associated with histopathologic evaluation, 30 cases(97%) in bone scan, 23 cases(74%) in CT image, and 19 cases(61%) in simple X-ray.3. Among the 11cases of bone infiltrative benign disease, a positive diagnosis associated with histopathologic evaluation, 11 cases(100%) in bone scan, 10 cases(91%) in CT image, and 6 cases(55%) in simple X-ray.4. Measurement of bone density in each group showed no statistical significant difference between malignant tumor and osteomyelitis as well as benign bone disease. But, a statistical significance was seen between osteomyelitis and benign bone disease.From this results, bone scan are more sensitive than simple X-ray and CT image in jaw lesion diagnosis, but specificity shows no significant difference. Therefore, it should be suggested that evaluation of bone scan must be carrying out in reference to final histopathologic diagnosis.]]>
Bone Density ; Bone Diseases ; Diagnosis ; Diagnosis, Differential ; Humans ; Jaw ; Osteomyelitis ; Sensitivity and Specificity ; Surgery, Oral

Chronic recurrent multifocal osteomyelitis (CRMO) is one of the most severe form of chronic non-bacterial osteomyelitis (CNO), which could result in bone and related tissue damage. This autoinflammatory bone disorder (ABD) is very difficult for its clinical diagnosis because of no diagnostic criteria or biomarkers. CRMO in the jaw must be suspected in the differential diagnosis of chronic and recurrent bone pain in the jaw, and a bone biopsy should be considered in chronic and relapsing bone pain with swelling that is unresponsive to treatment. The early diagnosis of CRMO in the jaw will prevent unnecessary and prolonged antibiotic usage or unnecessary surgical intervention. The updated researches for the identification of genetic and molecular alterations in CNO/CRMO should be studied more for its correct pathophysiological causes and proper treatment guidelines. Although our trial consisted of reporting items from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), there are very few articles of randomized controlled trials. This article was summarized based on the author's diverse clinical experiences. This paper reviews the clinical presentation of CNO/CRMO with its own pathogenesis, epidemiology, recent research studies, and general medications. Treatment and monitoring of the jaw are essential for the clear diagnosis and management of CNO/CRMO patients in the field of dentistry and maxillofacial surgery.
Biomarkers ; Biopsy ; Dentistry ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Epidemiology ; Humans ; Jaw ; Osteomyelitis ; Surgery, Oral