PERI-PROSTHETIC TOTAL JOINT INFECTION: George Cierny, MD
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THIS ARTICLE CAN BE READ, IN FULL, BY DOWNLOADING THE PDF FILE ( DOWNLOAD).
January 21, 2010
January 10, 2010
CHRONIC OSTEOMYELITIS: George Cierny
Developed by the Musculoskeletal Infection Society and published by AAOS, this is the first comprehensive orthopaedic literature digest devoted to identifying, preventing, and treating bone, joint, and soft tissue infections. The book distills knowledge and experience from over the last 5 years into a practical and accessible guide of current best practices.
Here, Drs. Cierny and DiPasquale have published their most recent update on the staging, treatment and outcomes for adult osteomyelitis and an entire chapter pertaining to the prevention of infection: Procedure-Related Reduction of the Risk of Infection (OKU_Musculo_Infection_ch_04). This text, and others pertaining to musculoskeletal pathology, can be purchased at the AAOS book store.
January 2, 2010
January 1, 2010
CHRONIC OSTEOMYELITIS OF THE TIBIA AND BONY DEFECTS: George Cierny, MD
Request: Dr. Cierny, my 17 year old son suffered a motorcycle accident and developed osteomyelitis five months after an open compound fx of his tibia. His surgeon removed about three inches of his bone and packed the wound with antibiotic “beads”. Now they want to perform a bone graft from his hip to his tibia. I am concerned and wondering if his doctors are up to date on the latest techniques. I want to avoid amputation. Any advice or help would be appreciated. 01/01/10; Atascadero, CA
Response: A type IIIB open fracture (Gustillo Classification) of the tibia with resultant infection and segmental osseous defect represents a formidable challenge in terms of restoring skeletal continuity and the ultimate achievement of a better functional result compared with that after successful amputation and prosthetic fitting. The extensive nature of the problem, the complexity of the reconstructive procedures that are needed and the fact that independent walking will usually not be possible for eighteen months or more, make this one of our most formidable challenges. Cierny, G; Infected Tibia1 Nonunions (1981-1995) The Evolution of Change. CORR, 1999; 360: 97-105.
A defect of ~3 inches (7.5cm) is usually refractory to iliac crest bone grafting, alone. The decision to reconstruct such a lesion should be based not only on the ability to control infection but also on the surgeon’s ability (experience, knowledge), the duration of treatment, and the extent of disability to be anticipated. May, Jupiter, Weiland and Byrd; Clinical Classification of Post-traumatic Tibial Osteomyelitis. JBJS, 1989;71:1422-1428.
Similarly, the best method of skeletal reconstruction is based on the availability of local and donor bone, defect length, condition of the soft tissues and patient age and health. See: TREATMENT RESULTS.
If you would send me a few photographs of his wounds (distant and close up) and a few, recent x-rays, I will generate a treatment plan with options and prognoses. GCIII; 01-01-10
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