Download PDF
Vet Comp Orthop Traumatol 2010; 23(02): 141-147
DOI: 10.3415/VCOT-09-09-0097
Case Report
Schattauer GmbH

Osteomyelitis-related sequestrum formation in association with the combination tibial plateau levelling osteotomy and cranial closing wedge osteotomy procedure

J. R. Maley
1   Sonora Veterinary Specialists, Phoenix, Arizona, USA
,
W. D. Mertens
2   Carolina Veterinary Specialists, Charlotte, North Carolina, USA
,
A. Bahr
3   PetRays Veterinary Radiology Consultants, Spring, Texas, USA
› Author Affiliations
Further Information

Publication History

Received: 10 September 2009

Accepted: 12 February 2009

Publication Date:
19 December 2017 (online)

    Permissions and Reprints

Summary

A twenty-eight-month old female spayed American Bulldog was presented for evaluation of a chronic draining tract and intermittent left hindlimb lameness twenty-eight weeks after a combination tibial plateau levelling osteotomy and cranial closing wedge osteotomy (TLPO/CCWO) had been performed. The patient had developed an infection of the surgical site three weeks postoperatively. Drainage persisted despite implant removal 10 weeks postoperatively and several weeks of culture and sensitivity-directed antibiotic therapy. Twenty-eight weeks postoperatively, a sequestrum was identified on radiographs. Surgical removal of the sequestrum resulted in resolution of the drainage. While osteomyelitis is a known complication of TPLO surgery, this case represents the first described case of osteomyelitis-related sequestrum formation in association with the combined TPLO/CCWO procedure

Keywords

Sequestrum - osteomyelitis - bone infection - tibial plateau levelling osteotomy - cranial closing wedge osteotomy
 

  • References

  • 1 An YH, Kang QK, Arciola CR.. Animal models of osteomyelitis. Int J Artif Organs 2006; 29: 407-420.
    CrossrefPubMedGoogle Scholar
  • 2 Bubenik LJ, Smith MM.. Orthopaedic Infections. In Slatter DH. editor Textbook of Small Animal Surgery. WB Saunders; Philadelphia: 1993: 1862-1974.
    Google Scholar
  • 3 Herron MR.. Osteomyelitis. In Bojrab M. editor Disease Mechanisms in Small Animal Surgery. Lea & Febiger; Philadelphia: 1993: 692-696.
    Google Scholar
  • 4 Horger M, Eschmann SM, Pfannenberg C. et al. The value of SPET/CT in chronic osteomyelitis. Eur J Nucl Med Mol Imaging 2003; 30: 1665-1673.
    CrossrefPubMedGoogle Scholar
  • 5 Madsen JL.. Bone SPECT/CT detection of a sequestrum in chronic-infected nonunion of the tibia. Clin Nucl Med 2008; 33: 700-701.
    CrossrefPubMedGoogle Scholar
  • 6 Nguyen VD, London J, Cone RO I. II. Ring Sequestrum: radiographic characteristics of skeleton fixation pin-tract osteomyelitis. Radiology 1986; 158: 129-131.
    CrossrefPubMedGoogle Scholar
  • 7 Parfitt SL, Fischetti AJ.. Clinical Snapshot: large osseous sequestrum of distal right humerus. Compend Contin Educ Vet 2008; 30: 144-153.
    PubMedGoogle Scholar
  • 8 Soontornvipart K, Necas M, Dvorak M.. Effect of Metallic Implant on the Risk of Bacterial Osteomyelitis in Small Animals. Acta Vet Brno 2003; 72: 235-247.
    CrossrefPubMedGoogle Scholar
  • 9 McPherson JC, Runner RR, Shapiro B. et al. An Acute Osteomyelitis Model in Traumatized Rat Tibiae Involving Sand as a Foreign Body, Thermal Injury, and Bimicrobial Contamination. Comp Med 2008; 58: 369-374.
    PubMedGoogle Scholar
  • 10 Ellington JK, Harris M, Hudson MC. et al. Intracellular staphylococcus aureus and antibiotic resistance: implications for treatment of staphylococcal osteomyelitis. J Orthop Res 2006; 24: 87-93.
    CrossrefPubMedGoogle Scholar
  • 11 Lucke M, Schmidmaier G, Sadoni S. et al. A new model of implant-related osteomyelitis in rats. J Biomed Mater Res 2003; 67: 593-602.
    PubMedGoogle Scholar
  • 12 Priddy NH, Tomlinson JL, Dodam JR. et al. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997–2001). J Am Vet Med Assoc 2003; 222: 1726-1732.
    CrossrefPubMedGoogle Scholar
  • 13 Talaat MB, Kowaleski MP, Boudrieau RJ.. Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibial for treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle. Vet Surg 2006; 35: 729-739.
    CrossrefPubMedGoogle Scholar
  • 14 Slocum B, Devine T.. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184: 564-569.
    PubMedGoogle Scholar
  • 15 Slocum B, Slocum TD.. Tibial plateau leveling osteotomy for repair of cranial cruciate rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
    CrossrefPubMedGoogle Scholar
  • 16 Moeller EM, Cross AR, Rapoff AJ.. Change in tibial plateau angle after tibial plateau leveling osteotomy in dogs. Vet Surg 2006; 35: 460-464.
    CrossrefPubMedGoogle Scholar
  • 17 Kowaleski MP, Apelt D, Mattoon JS. et al. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study. Vet Surg 2005; 34: 332-336.
    CrossrefPubMedGoogle Scholar
  • 18 Shahar R, Milgram J.. Biomechanics of tibial plateau leveling of the canine cruciate-deficient stifle joint: a theoretical model. Vet Surg 2006; 35: 144-149.
    CrossrefPubMedGoogle Scholar
  • 19 Robinson DA, Mason DR, Evans R. et al. The effect of tibial plateau angle on ground reaction forces 4–17 mMonths after tibial plateau leveling osteotomy in laborador retreivers. Vet Surg 2006; 35: 294-299.
    CrossrefPubMedGoogle Scholar
  • 20 Johnston BL, Conly JM.. Osteomyelitis management: more art than science?. Can J Infect Dis Med Micro 2007; 18: 115-118.
    PubMedGoogle Scholar
  • 21 Termaat MF, Raijmakers PGHM, Scholten HJ. et al. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87: 2464-2471.
    PubMedGoogle Scholar
  • 22 Mader JT, Ortiz M, Calhoun JH.. Update on the diagnosis and management of osteomyelitis. Clin Podiatr Med Surg 1996; 13: 701-724.
    PubMedGoogle Scholar
  • 23 Tas F, Siddik O, Bulut O. et al. Comparison of the diagnosis of plain radiography ultrasonography and magnetic resonance imaging in early diagnosis of acute osteomyelitis experimentally formed on rabbits. Eur J Radiol 2005; 56: 107-112.
    CrossrefPubMedGoogle Scholar
  • 24 Braden TD, Tvedten HW, Mostosky UV. et al. The sensitivity and specificity of radiology and histopathology in the diagnosis of post-traumatic osteomyelitis. Vet Comp Orthop Traumatol 1989; 3: 98-103.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Muir P, Johnson KA.. Anaerobic bacteria isolated from osteomyelitis in dogs and cats. Vet Surg 1992; 21: 463-466.
    CrossrefPubMedGoogle Scholar
  • 26 Dernell WS.. Treatment of severe orthopedic infections. Vet Clin North Am 1999; 29: 1261-1274.
    CrossrefPubMedGoogle Scholar
  • 27 Mackowiak PA, Jones SR, Smith JW.. Diagnostic value of sinus-tract cultures in chronic osteomyelitis. JAMA 1978; 239: 2772-2775.
    CrossrefPubMedGoogle Scholar
  • 28 Perry CR, Pearson RL, Miller GA.. Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the pre-operative assessment of osteomyelitis. J Bone Joint Surg Am 1991; 73: 745-749.
    CrossrefPubMedGoogle Scholar
  • 29 Dworkin R, Modin G, Kunz S. et al. Comparitive efficacies of ciprofloxacin, pefloxacin, and vancomycin in combination with rifampin in a rat model of methicillin-resistant staphylococcus aureus chronic osteomyelitis. Antimicrob Agents Chemother 1990; 34: 1014-1016.
    CrossrefPubMedGoogle Scholar
  • 30 Mader JT, Adams K, Morrison L.. Comparative evaluation of cefazolin and clindamycin in the treatment of experimental staphylococcus aureus osteomyelitis in rabbits. Antimicrob Agents Chemother 1989; 33: 1760-1764.
    CrossrefPubMedGoogle Scholar
  • 31 Nicholas P, Meyers BR, Levy RN. et al. Concentration of clindamycin in human bone. Antimicrob Agents Chemother 1975; 8: 220-221.
    CrossrefPubMedGoogle Scholar
  • 32 Norden CW.. Experimental chronic staphylococcal osteomyelitis in rabbits: treatment with Rifampin alone and in combination with other antimicrobial agents. Rev Infect Dis 1983; 5: 491-494.
    CrossrefPubMedGoogle Scholar
  • 33 Smilack JD, Flittie WH, Williams TW.. Bone concentrations of antimicrobial agents after parenteral administration. Antimicrob Agents Chemother 1976; 9: 169-171.
    CrossrefPubMedGoogle Scholar
  • 34 Ham K, Griffon D, Seddighi M. et al. Clinical application of tobrmycin-impregnated calcium sulfate beads in six dogs (2002–2006). J Am Anim Hosp Assoc 2008; 44: 320-326.
    CrossrefPubMedGoogle Scholar
  • 35 Koort JK, Makinen TJ, Suokas E. et al. Efficacy of ciprofloxacin-releasing bioabsorbable osteoconductive bone defect filler for treatment of experimental osteomyelitis due to staphylococcus aureus. Anti-microb Agents Chemother 2005; 49: 1502-1508.
    CrossrefPubMedGoogle Scholar
  • 36 Wenke JC, Owens BD, Svoboda SJ. et al. Effectiveness of commercially-available antibiotic impregnated implants. J Bone Joint Surg Br 2006; 88: 1102-1104.
    PubMedGoogle Scholar
  • 37 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and post-operative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998–2001). J Am Vet Med Assoc 2003; 222: 184-193.
    CrossrefPubMedGoogle Scholar
  • 38 Stauffer KD, Tuttle TA, Elkins AD. et al. Complications associated with 696 tibial plateau leveling osteotomies (2001–2003). J Am Anim Hosp Assoc 2006; 42: 44-50.
    CrossrefPubMedGoogle Scholar