Management of Chronic Osteomyelitis Following Gunshot Injuries : A Systematic Review of Literature

Abstract

Background: Chronic osteomyelitis of long bones are common in daily clinical practice, however, the treatment of these diseases has still been a challenge and difficult for orthopedic surgeons. Gunshot injuries lead to damage to bone and soft tissues that can complicate with bacterial invasion and cause bone infection. Many ways can overcome of bone infection, surgical debridement, bone fixation and antibiotic are used in management of chronic osteomyelitis. The objective of this systematic review was to review available studies reporting in management of chronic osteomyelitis following gunshot injuries and compare the methods used into the treatment. Methods: A comprehensive literature search was performed from the electronic databases Medline, PubMed, Google scholar, and Cochrane collaboration between 1995 and 2016. References were analyzed from included studies, inclusion criteria included (1) English literatures, (2) Humans clinical trials, (3) Orthopedic Journals only, (3) Definitive treatment strategy for management chronic osteomyelitis. In total, 5 articles were included in the systematic review. Results: A total of 278 patients from 5 studies were included in this systematic review. The mean age of the patients is all studies were 33.84 year, the ratio male to female is 6:1. The most of patients were classified as Gaustilio type lllB and CiernyMader type lllB. The result of all different studies shows a good outcome in 260 patients but 7 patients had poor outcome who were still had bone infection and one patient end by amputation. Radiographic X-ray did postoperative follow up every two weeks. The mean follow up duration was 40 months and all patients responsible for keep the fixator clean. Conclusion: Our systematic review showed that the patients with chronic osteomyelitis were treated by surgical debridement and bone fixation had a good result. But, this research lost the randomized trials methods, risk factors of patients, compare control groups and good statistical analysis. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious.