Today's News

Saturday, March 18, 2000

Limb salvage successful for tibial osteomyelitis

The decision to undergo a limb salvage procedure is difficult and multifaceted. The study in poster exhibit 454 reviews the outcomes of patients with chronic tibial osteomyelitis who underwent limb salvage in hopes to enhance the understanding of the impact this complex procedure has on the patient's ability to have a functional and fulfilling life.

The researchers found limb salvage appears to be a satisfactory option for patients with chronic tibial osteomyelitis. They said that the likelihood of returning to a functional level including ability to work and participate in previous recreational activities is very promising in the motivated patient.

Forty-six patients with at least 24 months follow-up, who had undergone limb salvage for chronic, refractory tibial osteomyelitis were evaluated by interview, examination and chart review. A modification of the Limb Extremity Outcomes Instrument was utilized emphasizing inquiries pertaining to quality of life.

A successful outcome is defined as pain-free independent ambulation, including the ability to perform activities of daily living. Pre-existing factors which may help to predict successful or poor outcome were evaluated and included: smoking history, age, Cierny-Mader classification, type of flap utilized and presence of intraarticular involvement.

Thirty-nine of the 46 (85 percent) patients had pain-free independent ambulation. A successful outcome was found in 70 percent of those patients more than 45 years old and in 100 percent of those less than 45 years of age. Of patients with a positive smoking history, 31 percent were failures and 71 percent of all poor outcomes were smokers. Seventy-one percent of failures were Cierny-Mader physiologic type B and anatomic type IV. Sixty-eight percent of patients were able to resume their prior occupation. Two patients with ipsilateral intraarticular involvement were associated with a poor outcome. All patients were infection free at last follow-up.

Co-authors of the study, all of the Keck School of Medicine, University of Southern California, are Michael J. Patzakis, MD, professor and chairman, department of orthopaedic surgery; Paul D. Holtom, MD, associate professor of clinical medicine and orthopaedics, division of infectious diseases, department of medicine; Randy Sherman, MD, professor and chairman, division of plastic surgery, department of surgery; Lane Shepherd, MD, assistant professor of orthopaedics, department of orthopaedic surgery; and Herrick J. Siegel, MD, resident, USC orthopaedic residency program.

Herrick J. Siegel, MD; Michael J. Patzakis, MD; Paul D. Holtom, MD; Randy Sherman, MD; and Lane Shepherd, MD.

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2000 Academy News March 18 Index C

Last modified 24/February/2000 by IS