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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 2, issue 4
J. Bone Joint Infect., 2, 184–193, 2017
© Author(s) 2017. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 2, 184–193, 2017
© Author(s) 2017. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 09 Oct 2017

Original full-length article | 09 Oct 2017

Osteomyelitis of the Pelvic Bones: A Multidisciplinary Approach to Treatment

Maria Dudareva, Jamie Ferguson, Nicholas Riley, David Stubbs, Bridget Atkins, and Martin McNally Maria Dudareva et al.
  • The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, OX3 7LD, United Kingdom

Keywords: Chronic osteomyelitis, pelvis, pressure ulcer, infection, surgical debridement.

Abstract. Background and Purpose: A case series review of chronic pelvic osteomyelitis treated with combined medical and surgical treatment by a multidisciplinary team.

Methods: All patients treated with surgical excision of pelvic osteomyelitis at our tertiary referral centre between 2002 and 2014 were included. All received combined care from a clinical microbiologist, an orthopaedic surgeon and a plastic surgeon. The rate of recurrent infection, wound healing problems and post-operative mortality was determined in all. Treatment failure was defined as reoperation involving further bone debridement, a requirement for the use of long-term suppressive antibiotics or sinus recurrence.

Results: Sixty-one adults (mean age 50.2 years, range 16.8-80.6) underwent surgery. According to the Cierny-Mader classification of osteomyelitis there were 19 type II, 35 type III and 7 type IV cases. The ischium was the most common site of infection. Osteomyelitis was usually the result of contiguous focus infection associated with decubitus ulcers, predominantly in patients with spinal or cerebral disorders. Most patients with positive microbiology had polymicrobial infection (52.5%). Thirty patients required soft tissue reconstruction with muscle or myocutaneous flaps.

Twelve deaths occurred a mean of 2.8 years following surgery (range 7 days-7.4 years). Excluding these deaths the mean follow-up was 4.6 years (range 1.5-12.2 years). Recurrent infection occurred in seven (11.5%) a mean of 1.5 years post-operatively (92 days - 5.3 years). After further treatment 58 cases (95.1%) were infection free at final follow-up.

Interpretation: Patients in this series have many comorbidities and risk factors for poor surgical outcome. Nevertheless, the multidisciplinary approach allows successful treatment in the majority of cases.

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