Chronic diaphyseal osteomyelitis of long bones refractory to conventional therapy - Benefits and risks of reaming of the femoral medullary cavity.

Abstract

Osteomyelitis of long bones represents a severe complication during fracture healing. If ongoing infection occurs despite reoperation and if antibiotic treatment is of no benefit, reaming of the medullary canal may be beneficial. We investigated the long term follow up (minimum 2 years) of patients submitted to reaming of the medullary canal to evaluate the efficacy of this method. Criteria for successful procedure: no further operative procedure/ antibiotic treatment. 32 patients out of 37 were followed over a 9 year period. Mean incidence of surgical treatment for osteomyelitis prior to reaming: 3.2 operations. Mean duration until reexamination after reaming: 3.7 years. 89% of patients had a full range of motion upon reexamination, in the others further articular injuries were present. 84.3% of patients were working in the same profession as prior to the fracture, 72% were active in sports again, 97% of patients were pain free. One otherwise healthy patient suffering from sclerosing osteitis (Garré) died during reaming of the femur due to bone marrow embolism to the lung. Reaming of the medullary canal has a high rate of curing osteomyelitis even after several previous attempts of surgical revisions and/or antibiotic treatment. The most likely mechanism is based on improvement of local perfusion. During surgery care must be taken not to provoke pulmonary embolization. Intraoperative monitoring by pulmonary artery catheter should performed; reaming should be immediately discontinued, if a rise in pulmonary artery pressure occurs.