Chronic Osteomyelitis Research Articles

Successful use of platelet-rich plasma as a regeneration technique for a non-healing diabetic leg ulcer with chronic osteomyelitis: A case report

Chronic diabetic leg ulcers can be challenging to manage, particularly when osteomyelitis coexists resulting in serious or even life-threatening conditions if not managed appropriately. Such cases require very long periods of treatment with several debridements, antibiotic bead implants, skin grafts or even amputations in many unfortunate cases. Despite that, conventional management appears to be inadequate with poor outcomes and a higher relapse rate. We report a case of a 26-year-old type 1 diabetic female patient presented with a history of non-healing diabetic leg ulcer complicated by chronic osteomyelitis of the left leg. Several wound debridements were performed with the application of vacuum-assisted closure, and culture-guided antibiotics were given. However, only minimal improvements were observed. Eventually, the leg was labeled as an unsalvagable limb due to poor blood supply based on an ankle-brachial index. Platelet-rich plasma (PRP) was tried showing promising results and significant improvement as confirmed by a gallium scan, which showed evidence of osteomyelitis remission. Two months later, the patient improved significantly with the ulcer healed and the osteomyelitis resolved. Autologous PRP promotes wound healing by providing necessary growth factors, reducing inflammation, and showing bactericidal activity. All efforts must be taken to preserve any limb before labeling it non-salvageable. This case report aimed to draw attention to the method that can be implemented to manage non-healing diabetic leg ulcers complicated by chronic osteomyelitis.

Induced Membrane Technique Combined with Surgical Lengthening of an Humerus Defect Secondary to Chronic Osteomyelitis: Case Report

Surgical management of long bone defects remains a considerable challenge for orthopedic surgeons, particularly in septic conditions. We present the case of an 8-year-old girl with a history of chronic osteomyelitis in the left humerus, referred to us following a pathologic fracture, initially managed with humeral osteosynthesis and grafting. Subsequently, the induced membrane technique was employed for pseudarthrosis after a recurrent fracture. Following consolidation, significant humeral shortening was observed, necessitating surgical lengthening using an external fixator, resulting in a satisfactory final outcome.

Chronic non-bacterial osteomyelitis associated with psoriasis.

Chronic non-bacterial osteomyelitis associated with psoriasis.

Bones on fire: illuminating osteomyelitis through the radiant lens of 18F-FDG PET/CT.

Osteomyelitis is an inflammatory process that is caused by an infecting microorganism and leads to progressive bone destruction and loss. Osteomyelitis can occur at any age and can involve any bone. The infection can be limited to a single portion of the bone or can involve several regions, such as marrow, cortex, periosteum, and the surrounding soft tissue. Early and accurate diagnosis plays a crucial role in reducing unnecessary treatment measures, improving the patient's prognosis, and minimizing time and financial costs. In recent years, the use of functional metabolic imaging has become increasingly widespread. Among them, 18F-FDG PET/CT has emerged as a cutting-edge imaging modality that combines anatomical and functional metabolic information. It has seen rapid development in the field of infectious diseases. 18F-FDG PET/CT has been demonstrated to yield acceptable diagnostic accuracy in a number of infectious and inflammatory diseases. This review aims to provide information about the 18F-FDGPET/CT in the use of chronic osteomyelitis,osteomyelitis secondary to a contiguous focus of infection and osteomyelitis associated with peripheral vascular disease.

Musculoskeletal symptoms and their impact on health-related quality of life in chronic nonbacterial osteomyelitis patients

IntroductionChronic non-bacterial osteomyelitis (CNO) is a rare, non-infection- related inflammatory disorder that affects children and teens. Clinical manifestations of CNO range widely from moderate, time-limited, monofocal inflammation of the bone to extreme multifocal or chronically active inflammation of the bone.ObjectivesThe main aim of this study was to explore the correlation between musculoskeletal (MSK) symptoms and health-related quality of life (HRQoL) in patients with CNO.MethodsChildren and adults with CNO and their parents were asked to answer a web-based survey. The survey consisted of multiple questions centered around demographic, clinical and therapeutic data, MSK discomfort form based on the Nordic MSK Questionnaire and HRQoL based on Pediatric Quality of Life Inventory-4 (PedsQL-4) and PedsQL rheumatology module. The inclusion criteria included diagnosis of CNO before the age of 18. Patients who had malignancies or any chronic rheumatic, MSK, neurological disease prior to CNO onset were excluded.ResultsThere was a total of 68 participants, mostly females (66.2%), with median age 14 years and median disease duration 4.75 years. The median number of bones affected by CNO was 5 and ranged from 1 to 24 bones. Among the studied patients, 45 patients (66.2%) had MSK manifestations at the last month. The most commonly affected part was ankle and feet (26.5%). Regarding HRQoL, patients with MSK manifestations had lower scores than did patients without in PedsQL-4 (p < 0.001) including domains of physical functioning (p < 0.001), emotional functioning (p = 0.033), social functioning (p < 0.001) and school functioning (p = 0.007) in addition to lower scores in PedsQL rheumatology module (p < 0.001) including domains of pain and hurt (p < 0.001), daily activities (p < 0.001), treatment (p = 0.035), worry (p = 0.001) and communication (p < 0.001).ConclusionMSK manifestations have a negative impact on HRQoL in CNO patients. So, early identification and treatment are highly recommended.

Chronic non-bacterial osteomyelitis of the mandible – orthodontic considerations and management: A case report

This case report describes the orthodontic management of a case of chronic non-bacterial osteomyelitis (CNO) of the mandible, a rare non-infective variant of osteomyelitis that exhibits a marked predilection in children and adolescents. The patient presented with a unilateral facial swelling associated with fluctuating pain. Radiographic examination, along with tissue biopsy and culture, as well as multispecialty input, led to confirmation of the diagnosis. There was no clear aetiological factor and pharmacological, symptomatic management was indicated. CNO requires multidisciplinary input, with good interspecialty communication and discussion, for an accurate diagnosis. Orthodontic management should be considered on a case-by-case basis, with tailored aims appropriate for each patient.

Efficacy of vancomycin-loaded Mg-hydroxyapatite scaffolds in chronic osteomyelitis

In this study, we develop a novel magnesium (Mg)/hydroxyapatite (HA) scaffold loaded with vancomycin (VAN) to provide long-lasting antibacterial activity for bone defect repair in chronic osteomyelitis (CO) in children. Firstly, the VAN-Mg/HA nanoparticles were successfully synthesized, as evidenced by X-ray diffraction analysis. Additionally, the VAN-Mg/HA nanoparticles extended the half-life of VAN by nearly 5-fold. Moreover, our results revealed that the VAN-Mg/HA nanoparticles exhibited a significant antibacterial effect, which was further enhanced with an increase in the concentration of Mg/HA nanoparticles. We also found that the VAN-Mg/HA nanoparticles enhanced the viability and migration of BMSCs, indicating good biocompatibility and osteoconductivity. Furthermore, the VAN-Mg/HA nanoparticles demonstrated higher expression levels of osteogenesis-related genes, such as alkaline phosphatase, RUNX2, and osteocalcin, showing good osteogenic properties. In conclusion, the VAN-Mg/HA scaffolds show great potential for antibiosis and bone regeneration in children with CO.

A case report of a rare course of secondary chronic odontogenic osteomyelitis of the upper jaw in a young patient

A case report of a rare course of secondary chronic odontogenic osteomyelitis of the upper jaw in a young patient

Vancomycin Three Ways: Multimodal Utilization of Intraoperative Antibiosis in Complex Foot and Ankle Infection

Osteomyelitis of the foot and ankle is an unfortunate, albeit pervasive, complication faced by orthopedic surgeons and their patients. Chronic osteomyelitis confers a great risk of amputation and protracted hospital admission in patients with diabetes, existing orthopedic hardware, and/or compromised tissue perfusion. The current standard of practice in the treatment of osteomyelitis is the initiation of broad antibiotic coverage followed by subsequent narrowing informed by culture data and sensitivities. While mild to moderate infections are treated with oral antibiotics, more severe infections are often treated using intravenous (IV) antibiotics. Vancomycin, in its IV form, is frequently administered intraoperatively for patients with osteomyelitis as it confers adequate coverage of common causative organisms, including staphylococcus aureus. However, given the diminished blood flow to distal extremities commonly seen in patients experiencing this complication, inadequate distribution of oral or IV antibiotics may occur. This is especially problematic, as it leads to an increased risk of recurrent infection and the ultimate need for amputation. Here, we present an alternate method of intraoperative vancomycin administration for patients with chronic osteomyelitis in the form of paste, powder, and injectable slurry. Postoperatively, oral or IV antibiotics are continued based on OR culture susceptibility. We found this to be an effective way to administer intraoperative antibiotics to ensure adequate osseous and soft tissue penetration in patients with complicated osteomyelitis of the foot and ankle. Level of Evidence: III.

Shock wave assisted intracellular delivery of antibiotics against bone infection with Staphylococcus aureus via P2X7 receptors

BackgroundTreatment of chronic osteomyelitis (bone infection) remains a clinical challenge; in particular, it requires enhanced delivery of antibiotic drugs for the treatment of intracellular Staphylococcus aureus (S. aureus), which prevents infection recurrence and resistance. Previous studies have found that noninvasive shock waves used to treat musculoskeletal diseases can alter cell permeability, however, it is unclear whether shock waves alter cell membrane permeability in chronic osteomyelitis. Furthermore, it remains unknown whether such changes in permeability promote the entry of antibiotics into osteoblasts to exert antibacterial effects. MethodsIn our study, trypan blue staining was used to determine the shock wave parameters that had no obvious damage to the osteoblast model; the effect of shocks waves on the cell membrane permeability of osteoblast model was detected by BODIPY®FL vancomycin; high performance liquid chromatography-mass spectrometry (HLPC-MS) was used to detect the effect of shock wave on the entry of antibiotics into the osteoblast model; plate colony counting method was used to detect the clearance effect of shock wave assisted antibiotics on S. aureus in the osteoblast model. To explore the mechanism, the effect of different pulses of shock waves on S. aureus was examined by plate colony counting method, besides, P2X7 receptor in osteoblast was detected by immunofluorescence and the extracellular ATP levels was detected. Furthermore, the effect of P2X7 receptor antagonists KN-62 or A740003 on the intracellular antibacterial activity of shock-assisted antibiotics was observed. Then, we used S. aureus to establish a rat model of chronic tibial osteomyelitis and investigated the efficacy and safety of shock-wave assisted antibiotics in the treatment of chronic osteomyelitis in rats. ResultsThe viability of the osteoblast models of intracellular S. aureus infection was not significantly affected by the application of up to 400 shock wave pulses at 0.21 mJ/mm2. Surprisingly, the delivery of BODIPY®FL vancomycin to osteoblast model cells was markedly enhanced by this shock wave treatment. Furthermore, the shock wave therapy increased the delivery of hydrophilic antibiotics (vancomycin and cefuroxime sodium), but not lipophilic antibiotics (rifampicin and levofloxacin), which improved the intracellular antibacterial effect. Afterwards, we discovered that shock wave treatment increased the extracellular concentration of ATP (the P2X7 receptor activator)， while KN-62 or A740003, a P2X7 receptor inhibitor, decreased intracellular antibacterial activity. We then found that 0.1 mL of 1 × 1011 CFU/mL ATCC25923 S. aureus was suitable for modeling chronic osteomyelitis in rats. Besides, the shock wave-assisted vancomycin treatment with the strongest antibacterial and osteogenic effects among the tested treatments was confirmed in vivo by imaging examination, microbiological cultures, and histopathology, with favorable safety. ConclusionsOur results suggest that shock waves can promote the entry of antibiotics into osteoblasts for antibacteria by changing the cell membrane permeability in a P2X7 receptor-dependent manner. Besides, considering antibacterial and osteogenic efficiency and a high degree of safety in rat osteomyelitis model, shock wave-assisted vancomycin treatment may thus represent a possible adjuvant therapy for chronic osteomyelitis.

Extracorporeal shock wave therapy: options in chronic osteomyelitis (literature review)

The use of extracorporeal shock wave therapy under experimental conditions has shown the effectiveness of the method in soft tissue and skeletal infections. In vitro, an energy-dependent effect of shock waves on reducing the viability of Staphylococcus aureus and other pathogenic flora was revealed. For the manifestation of the antibacterial activity of shock waves towards pathogenic bacteria of the typical flora in chronic osteomyelitis, at least 1,000 pulses were required, and for its almost complete eradication (99 %), 4,000 pulses were applied at an energy flux density of 0.59–0.96 mJ/mm2. Most authors confirm the isolated (without antibiotics) antibacterial effect of shock waves in vitro, although there are opposite opinions. It is known that pathogenic bacteria, including Staphylococcus aureus, form protective biofilms on infected soft, bone tissues, implants. Due to this, the emerging infection is difficult to treat for a number of reasons — the biofilm prevents the penetration of antibiotics and immune cells. In vitro studies have shown that shock waves destroy biofilms of pathogenic bacteria and create conditions for a joint bactericidal effect with antibiotics. In vivo observations under the conditions of modeling experimental osteomyelitis in animals have demonstrated bacteriologically that extracorporeal shock wave therapy, when used alone, does not have an antibacterial effect, however, a lower degree of osteomyelitis was detected morphologically. The authors stated the synergism of shock waves with antibiotics in the treatment of chronic osteomyelitis in animals, up to the bactericidal effect. Studies on the impact of shock waves on biofilms of pathogenic bacteria typical for soft tissue infections, chronic osteomyelitis, both in vivo and in vitro, showed that after the application of the method, the pathogenic flora becomes susceptible to antibiotic therapy. The currently widespread opinion about the contraindication of extracorporeal shock wave therapy in the presence of infection in the body, due to the risk of exacerbation of the inflammatory process, the likelihood of bacteremia, sepsis, and foci of secondary infection, has not been confirmed in the experimental studies in vivo. Many research have shown the absence of similar or other complications in animals after the use of shock waves. The analysis of the presented data indicates the need for further study of the mechanism of extracorporeal shock wave effect on chronic osteomyelitis, possible complications associated with the use of the method, as well as its approbation in the clinic.

P2RX7 gene variants associate with altered inflammasome assembly and reduced pyroptosis in chronic nonbacterial osteomyelitis (CNO)

Chronic nonbacterial osteomyelitis (CNO), an autoinflammatory bone disease primarily affecting children, can cause pain, hyperostosis and fractures, affecting quality-of-life and psychomotor development. This study investigated CNO-associated variants in P2RX7, encoding for the ATP-dependent trans-membrane K+ channel P2X7, and their effects on NLRP3 inflammasome assembly.Whole exome sequencing in two related transgenerational CNO patients, and target sequencing of P2RX7 in a large CNO cohort (N = 190) were conducted. Results were compared with publicly available datasets and regional controls (N = 1873). Findings were integrated with demographic and clinical data. Patient-derived monocytes and genetically modified THP-1 cells were used to investigate potassium flux, inflammasome assembly, pyroptosis, and cytokine release.Rare presumably damaging P2RX7 variants were identified in two related CNO patients. Targeted P2RX7 sequencing identified 62 CNO patients with rare variants (32.4%), 11 of which (5.8%) carried presumably damaging variants (MAF <1%, SIFT “deleterious”, Polyphen “probably damaging”, CADD >20). This compared to 83 of 1873 controls (4.4%), 36 with rare and presumably damaging variants (1.9%). Across the CNO cohort, rare variants unique to one (Median: 42 versus 3.7) or more (≤11 patients) participants were over-represented when compared to 190 randomly selected controls. Patients with rare damaging variants more frequently experienced gastrointestinal symptoms and lymphadenopathy while having less spinal, joint and skin involvement (psoriasis). Monocyte-derived macrophages from patients, and genetically modified THP-1-derived macrophages reconstituted with CNO-associated P2RX7 variants exhibited altered potassium flux, inflammasome assembly, IL-1β and IL-18 release, and pyroptosis. Damaging P2RX7 variants occur in a small subset of CNO patients, and rare P2RX7 variants may represent a CNO risk factor. Observations argue for inflammasome inhibition and/or cytokine blockade and may allow future patient stratification and individualized care.

Update on ocular manifestations of the main monogenic and polygenic autoinflammatory diseases.

Autoinflammatory diseases include disorders with a genetic cause and also complex syndromes associated to polygenic or multifactorial factors. Eye involvement is present in many of them, with different extent and severity. The present review covers ophthalmological lesions in the most prevalent monogenic autoinflammatory diseases, including FMF (familial Mediterranean fever), TRAPS (TNF receptor-associated periodic syndrome), CAPS (cryopyrin-associated periodic syndromes), Blau syndrome, DADA2 (deficiency of adenosine deaminase 2), DITRA (deficiency of the interleukin-36 receptor antagonist), other monogenic disorders, including several ubiquitinopathies, interferonopathies, and the recently described ROSAH (retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and headache) syndrome, and VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. Among polygenic autoinflammatory diseases, ocular manifestations have been reviewed in Behçet's disease, PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) syndrome, Still's disease and autoinflammatory bone diseases, which encompass CRMO (chronic recurrent multifocal osteomyelitis) and SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome.

Chronic otorrhea and osteomyelitis of the external auditory canal by Achromobacter xylosoxidans: an uncommon diagnosis

PurposeAchromobacter xylosoxidans is an emerging pathogen mainly associated with resistant nosocomial infections. This bacteria had been isolated in the ear together with other pathogens in cultures from patients with chronic otitis media, but it had never been reported as a cause of osteomyelitis of the external auditory canal.Case presentationWe present a unique case of a healthy 81-year-old woman who presented with left chronic otorrhea refractory to topical and oral antibiotic treatment. Otomicroscopy revealed an erythematous and exudative external auditory canal (EAC) with scant otorrhea. The tympanic membrane was intact, but an area of bone remodeling with a small cavity anterior and inferior to the bony tympanic frame was observed. Otic culture isolated multi-drug-resistant A. xylosoxidans, only sensitive to meropenem and cotrimoxazole. Temporal bone computed tomography showed an excavation of the floor of the EAC compatible with osteomyelitis. Targeted antibiotherapy for 12 weeks was conducted, with subsequent resolution of symptoms and no progression of the bone erosion.ConclusionsAtypical pathogens such as A. xylosoxidans can be the cause of chronic otitis externa. Early diagnosis and specific antibiotherapy can prevent the development of further complications, such as osteomyelitis. In these cases, otic cultures play an essential role to identify the causal germ. This is the first case of EAC osteomyelitis due to A. xylosoxidans reported to date.

КЛИНИЧЕСКИЙ СЛУЧАЙ РАЗВИТИЯ АБСЦЕССА ГОЛОВНОГО МОЗГА И ОСТРОГО ОДОНТОГЕННОГО СЕПСИСА У ПАЦИЕНТА С ДЕНТОФОБИЕЙ

Background data. A clinical case of brain abscess that occurred as a complication of chronic odontogenic osteomyelitis of the mandible on the background of a severe form of dentophobia. &#x0D; Subject. Chronic periodontitis is a possible cause of the development of potentially dangerous complications such as mediastinitis, thrombophlebitis, brain abscess, etc. Most often these complications arise due to untimely seeking medical help because of fear of dental intervention, the extreme manifestation of which is dentophobia. It is also known that odontogenic cause of cerebral abscess is foci of infection localised in the region of the maxilla.&#x0D; Objective: to study and describe a case of brain abscess, which occurred as a complication of chronic odontogenic osteomyelitis of the mandible on the background of a severe form of dentophobia.&#x0D; Materials and Methods. We analysed the medical records of a patient with odontogenic brain abscess resulting from a complication of chronic odontogenic osteomyelitis of the mandible on the background of severe dentophobia. &#x0D; Results. A patient with brain abscess developed as a result of exacerbation of chronic odontogenic osteomyelitis of the lower jaw was urgently hospitalised to the maxillofacial surgery department of the Tyumen General Hospital No. 2. &#x0D; From the anamnesis it is known that during 1.5 years the patient had repeatedly applied to the Tyumen General Hospital No. 2 for chronic apical periodontitis, however, he did not agree to surgical treatment because of fear of dental intervention. Further, despite the deterioration of his condition, he twice refused hospitalisation. &#x0D; During his stay in hospital, the patient received surgical and intensive medical care. After treatment, he was discharged with residual neurological consequences. Psychocorrection of dentophobia was prescribed.&#x0D; Conclusions. 1. The cause of brain abscess may be an odontogenic inflammatory process localised in the mandible. 2. Dentophobia leads to untimely medical care and may be the cause of serious complications.

Collaborative approach to paediatric chronic non-bacterial osteomyelitis of the mandible: Great Ormond Street Hospital case series

This paper outlines a 10-patient case series of chronic non-bacterial osteomyelitis (CNO) of the mandible at a tertiary paediatric hospital in the UK. Our findings highlight the homogeneous presenting signs and symptoms of an intermittently painful, swollen angle and ramus of the mandible. We present the typical laboratory investigative findings (normal inflammatory markers) and imaging appearances (sclerosis and periosteal oedema). Our paper outlines an investigation protocol, including recommendations for extraoral bone biopsies and systemic magnetic resonance imaging (MRI). We explain the importance of multidisciplinary care, with combined care by rheumatologists and infectious disease specialists. Finally we demonstrate the efficacy of our treatment algorithm for oral non-steroidal anti-inflammatory drugs (NSAIDs), and in those cases refractory to NSAIDS, intravenous pamidronate. This paper provides a useful addition to the literature by informing OMF surgeons of this rare condition and given the clinical equipoise in treatments, it can hopefully guide clinicians in an investigation pathway and management protocol.

Maxillary Osteomyelitis: A Case Report Highlighting Diagnosis and Treatment Challenges

Osteomyelitis, a condition characterized by inflammatory bone infection involving the medullary cavity, haversian systems, and periosteum, is relatively rare but grave. Historically more prevalent prior to the antibiotic era, it remains a formidable challenge, particularly when comorbid with systemic illnesses such as diabetes mellitus. This case report details the presentation of a 70-year-old male with poorly controlled diabetes mellitus presenting with maxillary osteomyelitis, evidenced by tooth mobility, purulent discharge, and exposed bone areas. Radiographic assessment revealed extensive maxillary bone involvement, corroborated by histopathological examination confirming chronic osteomyelitis. Treatment entailed partial maxillectomy under local anesthesia, necessitated by financial constraints, followed by subsequent monitoring and prosthesis placement. This case underscores the significance of timely diagnosis, interdisciplinary management, and the complexities inherent in treating osteomyelitis complicated by systemic diseases.

Whole-Body MRI at Initial Presentation of Chronic Recurrent Multifocal Osteomyelitis, Juvenile Idiopathic Arthritis, Their Overlapping Syndrome, and Non-Specific Arthropathy.

(1) Background: Whole-body magnetic resonance imaging (WB-MRI) is central to defining total inflammatory burden in juveniles with arthritis. Our aim was to determine and compare the initial distribution of lesions in the WB-MRI in patients with chronic recurrent multifocal osteomyelitis (CRMO), juvenile idiopathic arthritis (JIA), their overlapping syndrome (OS), and with Non-specific Arthropathy (NA). (2) Methods: This retrospective single center study was performed on an Avanto 1.5-T MRI scanner with a dedicated multichannel surface coil system. A total of 173 pediatric patients were included with the following final diagnoses: CRMO (15.0%), JIA (29.5%), OS (4.6%), and NA (50.9%). (3) Results: Bone marrow edema (BME) was the most common abnormality, being seen in 100% patients with CRMO, 88% with OS, 55% with JIA, and 11% with NA. The bones of the lower extremities were the most affected in all compared entities. Effusion was seen in 62.5% children with OS, and in 52.9% with JIA, and in CRMO and NA, the exudate was sporadic. Enthesitis was found in 7.8% of patients with JIA and 3.8% with CRMO, and myositis was seen in 12.5% of patients with OS and in 3.9% with JIA. (4) Conclusions: The most frequent indication for WB-MRI in our center was JIA. The most common pathology in all rheumatic entities was BME, followed by effusion mainly seen in in OS and JIA. Enthesitis and myositis were less common; no case was observed in NA.

In-label, off-label prescription, efficacy and tolerability of dalbavancin: report from a National Registry

PurposeAlthough dalbavancin is currently approved for the treatment of ABSSIs, several studies suggest its efficacy and tolerance as long-term therapy for other off-label indications requiring prolonged intravenous antibiotic administration.MethodsWe conducted a prospective nationwide study of dalbavancin use in real-life settings for both approved and off-label indications analysing for each case the clinical and microbiological characteristics of infection the efficacy and safety of treatments.ResultsDuring the study period (from December 2018 to July 2021), the ID specialists from 14 different centres enrolled 223 patients treated with dalbavancin [141 males (63%) and 82 females (37%); male/female ratio 1.72; mean age 59 (SD 17.2) years, (range 15–96). Most patients in the study population (136/223; 61.0%) came from community rather than health care facilities and most of them were visited in Infectious Diseases wards (93/223; 41.7%) and clinics (55/223; 24.7%) even though some patients were cured in other settings, such as surgery wards (18/223; 8.1%), orthopaedic wards (11/223; 4.9%), Emergency Rooms (7/223; 3.1%) and non-surgical other than ID wards (6/223; 2.7%). The most common ID diagnoses were osteomyelitis (44 cases/223; 19.7%; of which 29 acute and 15 chronic osteomyelitis), cellulitis (28/223; 12.5%), cutaneous abscess (23/223; 10.3%), orthopaedic prosthesis-associated infection (22/223; 9.9%), surgical site infection (20/223; 9.0%) and septic arthritis (15/223; 6.7%).ConclusionIn conclusion, by virtue of its PK/PD properties, dalbavancin represents a valuable option to daily in-hospital intravenous or outpatient antimicrobial regimens also for off-label indications requiring a long-term treatment of Gram-positive infections.

Functional Ankle Reconstruction Technique After Total Calcanectomy.

Although comminuted fractures, osteomyelitis, large skin ulcers, and malignant tumors are rarely seen in the calcaneus, it is a problematic region to treat because it is not an actual compartment and has insufficient blood supply. Few foot and ankle surgeons would recommend total calcanectomy in various cases of malignant tumors, comminuted fractures, ulcerations of the heel often seen in diabetic patients, and chronic osteomyelitis. After calcanectomy, if functional reconstruction is not performed, the patient will experience loss of function, pain, wound problems, talonavicular dislocations, and additional surgical interventions. In this study, we demonstrate calcanectomy and simultaneous functional reconstruction techniques while discussing the patients' results. We retrospectively evaluated three patients who underwent total calcanectomy between January 1, 2001, and December 31, 2020.Two of these procedures were due to osteomyelitis of the calcaneus after trauma, and one was due to a chondroblastic osteosarcoma of the calcaneus. The patients were followed up for an average of 116 months. None of the patients developed problems with their wounds in the postoperative term or during follow-up. Total calcanectomy as a surgical method of limb salvage yields successful results. We believe that these results can be improved with functional reconstruction and rehabilitation with custom-made shoes, and the results do not entail additional morbidity or require additional hindfoot bone reconstruction.