Articles | Volume 6, issue 5
https://doi.org/10.5194/jbji-6-151-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-6-151-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
28 Apr 2021
Original full-length article |
| 28 Apr 2021
| 28 Apr 2021
A retrospective cohort study comparing clinical outcomes and healthcare resource utilisation in patients undergoing surgery for osteomyelitis in England: a case for reorganising orthopaedic infection services
Jamie Ferguson
CORRESPONDING AUTHOR
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, OX3 7HE, UK
Myriam Alexander
Open Vie, Marlow, UK
Stuart Bruce
Health Economic and Outcomes Research Consultant, University of Otago, Dunedin, New Zealand
Matthew O'Connell
Harvey Walsh, Cheshire, UK
Sue Beecroft
Harvey Walsh, Cheshire, UK
Martin McNally
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, OX3 7HE, UK
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J. Bone Joint Infect., 8, 133–142, https://doi.org/10.5194/jbji-8-133-2023, https://doi.org/10.5194/jbji-8-133-2023, 2023
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This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
Max Mifsud, Jamie Y. Ferguson, David A. Stubbs, Alex J. Ramsden, and Martin A. McNally
J. Bone Joint Infect., 6, 63–72, https://doi.org/10.5194/jbji-6-63-2020, https://doi.org/10.5194/jbji-6-63-2020, 2020
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Chronic bone infections often present with major bone and soft tissue loss which can be difficult to manage. In this study, we treated the most complex infections using surgery which reconstructed all of the tissues in one operation.
We showed that this was a safe approach with very good outcomes. All of the bones healed and 96.5 % of patients were infection-free at final follow-up. This type of surgery requires close cooperation of a multidisciplinary team with expertise in major infections.
Josefine Slater, Maiken Stilling, Andreas Engel Krag, Sara Kousgaard Tøstesen, Mads Kristian Duborg Mikkelsen, Martin McNally, Alexander James Ramsden, Louise Kruse Jensen, Birgitte Jul Kiil, and Mats Bue
J. Bone Joint Infect., 10, 597–607, https://doi.org/10.5194/jbji-10-597-2025, https://doi.org/10.5194/jbji-10-597-2025, 2025
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We developed a pig model to study how different tissue flaps support the healing microenvironment of lower-leg composite defects. By measuring tissue metabolism and examining tissue samples under the microscope, we found distinct early responses between muscle and fascia-based flaps. This model may help researchers and clinicians better understand the healing of complex bone and soft-tissue defects and may provide a platform for evaluating clinically relevant ortho-plastic outcomes.
Antonio Loro, Fulvio Franceschi, Muhumuza M. Fisha, Emmanuel Ewochu, Geoffrey Mwanje, Annamaria Dal Lago, and Martin McNally
J. Bone Joint Infect., 10, 155–163, https://doi.org/10.5194/jbji-10-155-2025, https://doi.org/10.5194/jbji-10-155-2025, 2025
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This retrospective study shows that autogenous non-vascularized bone graft is a viable option for managing post-osteomyelitis bone defects in children in low-resource settings. Bone union was achieved in all cases at the last follow-up (minimum of 7 years). Recurrence of infection was seen in two cases. Studies into this specific technique are important as it does not require super-specialized centres or skills, both of which are scarce in low-resource settings.
Asanka Wijendra, Alex Ramsden, and Martin McNally
J. Bone Joint Infect., 8, 183–188, https://doi.org/10.5194/jbji-8-183-2023, https://doi.org/10.5194/jbji-8-183-2023, 2023
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Cancerous transformation is a rare but potentially life-threatening complication of chronic bone infection. As with all forms of cancer, early detection and diagnosis is crucial to outcome.
Whilst there have been over 100 cases of chronic bone infection with cancerous transformation reported in the literature between 1999 and 2020, this is the first case report to document transformation with 20 years of concordant imaging and clinical review.
Niels Vanvelk, Esther M. M. Van Lieshout, Jolien Onsea, Jonathan Sliepen, Geertje Govaert, Frank F. A. IJpma, Melissa Depypere, Jamie Ferguson, Martin McNally, William T. Obremskey, Charalampos Zalavras, Michael H. J. Verhofstad, and Willem-Jan Metsemakers
J. Bone Joint Infect., 8, 133–142, https://doi.org/10.5194/jbji-8-133-2023, https://doi.org/10.5194/jbji-8-133-2023, 2023
Short summary
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This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
Maria Dudareva, Andrew Hotchen, Martin A. McNally, Jamie Hartmann-Boyce, Matthew Scarborough, and Gary Collins
J. Bone Joint Infect., 6, 257–271, https://doi.org/10.5194/jbji-6-257-2021, https://doi.org/10.5194/jbji-6-257-2021, 2021
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Clinical prognostic models are tools that predict treatment outcomes for individual patients. For adults with bone and joint infection treated with surgery and implant removal, this review found no existing unbiased clinical prediction models that took modifiable health factors into account to estimate prognosis. Developing a clinical prognostic model may help treatment decisions and future targeted research in orthopaedic infection.
Martin McNally
J. Bone Joint Infect., 6, 199–201, https://doi.org/10.5194/jbji-6-199-2021, https://doi.org/10.5194/jbji-6-199-2021, 2021
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This paper provides further evidence that treatment of osteomyelitis by serial debridement without the use of local antimicrobials has high recurrence rates (20 %–30 %). The addition of bioglass did not improve this compared to using bone graft alone. Additional systemic antibiotic was required in many cases, increasing the risk of antimicrobial resistance. Recent series of single-stage surgery with local antibiotic delivery have reported better outcomes.
Martina Galea Wismayer, Kurstein Sant, Ryan Giordmaina, and Martin McNally
J. Bone Joint Infect., 6, 141–145, https://doi.org/10.5194/jbji-6-141-2021, https://doi.org/10.5194/jbji-6-141-2021, 2021
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We report the treatment of bone infection in a patient with a rare disease which causes overgrowth of the limb. Careful assessment of the scans showed that the infection was in some new bone which had formed in the soft tissues after a minor injury to the leg and not in one of the major bones. This made treatment much easier with a successful outcome.
Max Mifsud, Jamie Y. Ferguson, David A. Stubbs, Alex J. Ramsden, and Martin A. McNally
J. Bone Joint Infect., 6, 63–72, https://doi.org/10.5194/jbji-6-63-2020, https://doi.org/10.5194/jbji-6-63-2020, 2020
Short summary
Short summary
Chronic bone infections often present with major bone and soft tissue loss which can be difficult to manage. In this study, we treated the most complex infections using surgery which reconstructed all of the tissues in one operation.
We showed that this was a safe approach with very good outcomes. All of the bones healed and 96.5 % of patients were infection-free at final follow-up. This type of surgery requires close cooperation of a multidisciplinary team with expertise in major infections.
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