Post-Traumatic Chronic Osteomyelitis: A Rare and Problematic Diagnosis?

Abstract

Background: Post-traumatic chronic osteomyelitis (PTCO) is a rare but severe complication of fracture treatment. Methods: We evaluated the incidence and prevalence of PTCO, and the role of imaging in its diagnosis by means of questionnaires sent to a representative selection of trauma surgeons in Dutch teaching and general hospitals. Results: The estimated incidence of suspected PTCO was 2.2 cases a year in general hospitals and 27.5 cases a year in teaching hospitals (p = 0.01). The overall incidence was calculated as 1 : 38 000 inhabitants per year. The prevalence of PTCO was significantly lower in general hospitals than in teaching hospitals (two versus eight patients; p = < 0.001). The overall prevalence was calculated as 1 : 70 000 inhabitants. The risk of developing PTCO after operative treatment was 0.64 %. Eighty-three percent of the respondents considered diagnostic imaging to adequately distinguish soft tissue infections from osteomyelitis; in contrast, 86 % of respondents considered diagnostic imaging to have little effect on final surgical treatment and 14 % thought it had a modest effect. Conclusions: PTCO, although a rare diagnosis, is a major problem for individual patients. A wide range of available imaging techniques is considered helpful for diagnosing PTCO, but the results of these procedures have few consequences for surgical treatment.

Key words

questionnaire - epidemiology - post-traumatic - chronic osteomyelitis

References

• 1 Boxma H, Broekhuizen T, Patka P, Oosting H. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial.  Lancet. 1996;  347 1133-1137
• 2 Braun T I, Lober B. Chronic Osteomyelitis. Springer, New York 1988
• 3 Cunha B A. Osteomyelitis in elderly patients.  Clin Infect Dis. 2002;  35 287-293
• 4 Dirschl D R, Almekinders L C. Osteomyelitis. Common causes and treatment recommendations.  Drugs. 1993;  45 29-43
• 5 Eerenberg J. Taurolidine in the treatment of experimental post-traumatic osteomyelitis. VUMC 1996
• 6 Ehara S. Complications of skeletal trauma.  Radiol Clin North Am. 1997;  35 767-781
• 7 Gross T, Kaim A H, Regazzoni P, Widmer A F. Current concepts in posttraumatic osteomyelitis: a diagnostic challenge with new imaging options.  J Trauma. 2002;  52 1210-1219
• 8 Haas D W, McAndrew M P. Bacterial osteomyelitis in adults: Evolving considerations in diagnosis and treatment.  Am J Med. 1996;  101 550-561
• 9 Kaim A H, Gross T, Schulthess G K von. Imaging of chronic posttraumatic osteomyelitis.  Eur Radiol. 2002;  12 1193-1202
• 10 Mader J T, Ortiz M, Calhoun J H. Update on the diagnosis and management of osteomyelitis.  Clin Pediatr Med Surg. 1996;  13 701-724
• 11 Mader J T, Shirtliff M, Calhoun J H. Staging and staging application in osteomyelitis.  Clin Infect Dis. 1997;  25 1303-1309
• 12 Moses L E, Oakford R V. Tables of Random Permutations. Stanford University Press, Stanford, CA 1978
• 13 Schauwecker D S. Osteomyelitis: Diagnosis with In-111-labeled leukocytes.  Radiology. 1989;  171 141-146
• 14 Tsukayama D T. Pathophysiology of posttraumatic osteomyelitis.  Clin Orthop. 1999;  360 22-29
• 15 Waldvogel F A, Medoff G, Swartz M N. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. 3. Osteomyelitis associated with vascular insufficiency.  N Engl J Med. 1970;  282 316-322