CHRONIC POSTTRAUMATIC OSTEOMYELITIS OF THE FEMUR: TREATMENT, MICROBIOLOGY, OUTCOME

Purpose: Chronic posttraumatic osteomyelitis of the femur is still a great challenge for medical treatment. Bacterial colonization after multi-fragment fractures often complicates and extends bone healing. Muti-modal management including hyperbaric oxygenotherapy and frequent lavage and debridement as well as use of systemically and locally applied antibiotics are needed to eradicate infection. This study introduces our treatment regime for chronic posttraumatic osteomyelitis of the femur and presents our results. Material and Method: We reviewed 24 patients with posttraumatic osteomyelitis after femoral shaft fractures treated at our trauma center. We analyzed the bacterial spectrum, changes in bacterial spectrum during treatment, numbers of operative revisions and hyperoxygenotherapy cycles, as well as over all hospitalisation time, and outcome concerning bone healing. Results: Staphylococci were the most frequently found bacteria at first revision, followed by Enterobacter species. Average length of treatment was 8.3 (1–29) months. An average of 11.5 (2–32) operative revisions including intramedullar debridement were performed, additionally 10 patients underwent a mean of 29 (3–81) hyperoxygenotherapy cycles. Re-Infection after treatment occured in 7 cases, in 2 patients amputation was needed to eradicate infection. Conclusions: Our results show, that the chronic post-traumatic osteomyelitis of the femur is an insistent disease that needs to be treated interdisciplinary over a long period of time. Our treatment regime produces satisfying results. Individual solutions are necessary to reach an infection-free status.