Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Abstract

Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free long-term follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a "trough" (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2-6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol.

Figures

Fig. 1

Anteroposterior (left) and lateral (right) views of patient no. 24 with right distal tibial osteomyelitis. This male patient symptomatic for 8 years. The ankle joint had been ankylosed as the result of infection

Fig. 2

Magnetic resonance image showing pus collection in the distal tibial medulla, oedema and anteroinferior cortical destruction

Fig. 3

Intraoperative view after debridement by means of a trough, irrigation and vancomycin-impregnated bead application

Fig. 4

Early postoperative radiograms. Antibiotic beads were placed in the post-debridement 8–9 cm from the joint level

Fig. 5

Follow-up radiograms after bead removal. The patient was asymptomatic and had normal radiographic and laboratory findings