Management of Osteroarticuler Infection by Different Treatment Options

Abstract

Background & Objectives: Osteo-articular infections (OI) are a common problem and challenging for Orthopedic Surgeons. The consequences can be local manifestations to a systemic infection or limb loss. Accurate diagnosis is necessary for good treatment and control the drastic consequences. Conventional treatment may require antibiotics for prolonged duration according to culture and sensitivity. Our study objective was to determine osteo-articular infection and the effectiveness of treatment modalities. Place & duration of study: This study was a case series done at the Department of Orthopedic Surgery KEMU/Mayo Hospital, Lahore from December 2010 to March 2013. Methods: We included 200 hemodynamically stable patients 18 to 55 years of age of either gender with osteo-articular infection. They were diagnosed on history, clinical examination both local and systemic, previous treatment, previous surgical procedure and baseline included CBC, ESR, CRP, LFT's with albumin, globulin, RFT's, blood sugar random, affected joint radiographs, pus & soft tissue culture sensitivity, CT scan and MRI. We managed all patients both medically and surgically who presented with infection of bone and joint due to trauma, hospital acquired infection or due to hematogenous spread. We followed patients in out-patient department for six months and observed the post-operative treatment outcomes. Results: Out of the total 200 patients, majority 172 (86%) were male and 28 (14%) were female. Lower limb infection was observed in 128 (64%) patients, while 46 (23%) patients had upper limb infection, and 27 (13.5%) patients had septic arthritis of lower limb. Treatment outcomes were observed and there were excellent outcomes in 31 (15.5%) patients, good in 56 (28%), fair in 69 (34.5%) and poor in 43 (21.5%) patients. Conclusion: Staphylococcus aureus is the most common causative organism of osteoarticular infection. Males are predominantly affected. Antibiotic regime for 03 weeks according to culture and sensitivity is the most effective treatment in conjunction with surgical wound debridement, curettage, arthrotomy, sequestrectomy and exchange of infected prosthesis show favourable outcomes.