Antibiotic targeted cement rods in chronic osteomyelitis, short-term outcomes from a level one South African trauma centre

Abstract

Background: Chronic osteomyelitis requires complex management plans. Meta-analyses and systematic reviews have not found a gold standard of treatment for this disease. However, the literature reviews various treatment options. This study assesses the efficacy of an alternative treatment protocol to what is generally used in South Africa. This treatment protocol involves debridement, reaming and irrigation; as well as targeted antibiotics, used in a cheaply, effectively, and easily made cement rod spacer. Methods: A retrospective record review was performed on 38 patients, diagnosed with chronic osteomyelitis secondary to a long bone fracture, whom were treated via a specified treatment protocol at Chris Hani Baragwanath Academic Hospital between 01 January 2017 and 31 December 2018. This treatment protocol involved staged surgery with the use of antibiotics and antibiotic tailored cement rods. Data were collected and analysed accordingly using Stata 16.0, 2019. Results: The results indicate that chronic osteomyelitis is most prevalent amongst young males with a median age of 36 years. A multitude of organisms were cultured from bone reamings suggesting targeted antibiotic therapy is required. This treatment protocol demonstrated a 75.7% microbiological resolution to a negative culture. A good clinical outcome of 84.2% overall was demonstrated in terms of sinus resolution, skin changes, pain and function. All inflammatory markers decreased post-treatment with C - reactive protein showing a statistically significant decrease (p = 0.0043). Conclusion: Chronic osteomyelitis remains a complex disease to treat. Our treatment protocol demonstrates favourable microbiological, serological and overall clinical outcomes. Our study highlights antibiotic targeted cement rods as a feasible treatment option in managing chronic osteomyelitis secondary to long bone fractures.