presentazione di powerpoint - osteomyelitis · 2015-02-21 · cl romanò - infection and...

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CL Romanò - Infection and Osteosynthesis : the ICS Classification as a Guideline for Treatment

Infection and osteosynthesis: the ICS classification

as a guideline for treatment

C.L. Romanò

Centro di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari

I.R.C.C.S. Istituto Ortopedico Galeazzi, Milano

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Infection and Osteosynthesis

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• 2.195 patients

• Prospectic, randomized, double blind

• Osteosynthesis for closed fractures of long bones

• Placebo: 8.3 %

• Prophylaxis (ceftriaxone): 3.6% (p<0.001)

Boxma H, Broekhuizen T, Patka P, Oosting H. (1996) Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. Lancet 27; 347 :1133-7


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• Gustilo I 0.5 – 4.0 %

• Gustilo II 2.0 – 7.0 %

• Gustilo III 10.0 – 25.0 %

Gustilo R.B., Mendoza R.M., Williams D.N.: Problems in the management of type III open fractures. A new classification of type III open fractures. J. Trauma, 24: 742-746, 1984.


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• Osteosynthesis: temporary function, while bone healing occurs.

• Bone infection may delay, but does not preventi, in itself, bone healing, provided that the stability of the synthesis is mainatained.

Court-Brown CM et al. (1992) Infection after intramedullary nailing of the tibia. Incidence and protocol for management. J Bone Joint Surg Br 74(5):770–774

Green SA et al (1987) Chronic sepsis following intramedullary nailing of femoral fractures. J Trauma 27(1):52–57 Laky R (1989) Results of treatment of infected osteosynthesis cases. Magy Traumatol Orthop 32(3):187–193

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ICS Classification

Archivio di Ortopedia e Reumatologia (2006). Vol. 117:8-11.

Profilassi dell’infezione nell’osteosintesi e classificazione “ICS” come guida al trattamento.

Romanò C.L., Zavatarelli A., Tinti G., Meani E.

Quaderni di Infezioni Osteoarticolari (2001) Apr; 2:3-16.

Infection after osteosynthesis: the conservative surgical treatment

Romanò C.L., Pellegrini A., Tinti G., Meani E.

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Type I Type II Type III

Infection

Callus

Stability

Infection after Osteosynthesis

ICS Classification

Archivio di Ortopedia e Reumatologia (2006) . Vol. 117:14-15.

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I C S Type I

Leave the synthesis in situ.

Antibiotic therapy.

Ev. surgical debridment.

Ev. sequestrectomy.

Ev. local antibiotic therapy.

I

C

S

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I C S Type II

Leave the synthesis in situ.

Antibiotic therapy.

Physical bone stimulation.

Ev. surgical debridment.

Ev. sequestrectomy.

Ev. local antibiotic therapy.

Dinamization.

Bone substitutes & Growth factors ?

I

C

S

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I C S Type III

Remove and change the synthesis.

Physical bone stimulation.

Ev. bone resection.

Ev. bone transport.

Ev. bone grafts.

Ev. segmental prosthesis.

Bone substitutes & Growth factors ?

I

C

S

7 months from trauma

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I

C

S

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I

C

S

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7 months later

I

C

S

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I

C

S

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ICS Type I II III Total

Raw data % Raw data % Raw data % Raw data %

N. patients 93 85 37 215

Lost to follow-up 6 6,5 6 7,1 3 8,1 15 7,0

Mean follow-up

(years) 3.4 +- 1.2 3.6 +- 1.3 3.3 +- 1.2 3.4 +- 1.3

Bone healing 82 94,3 68 86,1 33 97,1 183 91,5

No infection

recurrence 81 93,1 72 91,1 33 97,1 186 93,0

Tybe B hosts 24 27,6 18 22,8 14 41,2 56 28,0

Type C hosts 12 13,8 14 17,7 11 32,4 37 18,5

Complications 7 7,5 6 7,1 9 24,3 22 10,2

Grade change 4 5,7 12 13,9 0 0,0 16 7,4

Clinical results (year 2005 – 2009)

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1. Bone and joint infections are an heterogenous group of diseases

2. Infection after osteosynthesis is a challenging complication and requires:

1. Classification

2. Targeted management

3. Specialized centers and teams

Conclusions

presentazione di powerpoint - osteomyelitis · 2015-02-21 · cl romanò - infection and...

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