Chronic Refractory Osteomyelitis Research Articles

Quality of Life Assessment of Patients With Posttraumatic Fracture Nonunion, Chronic Refractory Osteomyelitis, and Lower-Extremity Amputation

One hundred nine patients with long-bone fracture nonunion, chronic refractory osteomyelitis, and posttraumatic amputation were evaluated to assess the impact of chronic disability on the quality of life. The quality of life parameters were defined by a functional assessment instrument, the Arthritis Impact Measurement Scale (AIMS), and a Psychosocial Adjustment to Illness Scale (PAIS). A spouse PAIS self-report instrument was administered to assess the psychosocial adjustment of spouses or significant others. A final questionnaire was developed to determine the reasons, in order of their importance, for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and nonunion or amputation patients. The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients. Subscale analysis of AIMS scores showed significant differences among the three groups with respect to health perception and scale of orthopaedic problem. The osteomyelitis patients were more severely affected than the nonunion or amputation patients. The PAIS was unable to detect any statistically significant differences in psychosocial adjustment of the spouses of patients in each of the three population groups. The most frequent reason for continuing medical and surgical management of nonunion and osteomyelitis was hopeful expectation for cure. The group who chose amputation did so in an attempt to put an end to the need for medical and surgical treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation. This study provides further insight into the quality of life experience for patients with long-term orthopaedic problems.

Uses of hyperbaric oxygen therapy in the 1990s.

Hyperbaric oxygen can produce a variety of effects in addition to reducing air and gas embolism. It increases the killing ability of leukocytes and is lethal to certain anaerobic bacteria. It inhibits toxin formation by certain anaerobes, increases the flexibility of red cells, reduces tissue edema, preserves intracellular adenosine triphosphate, maintains tissue oxygenation in the absence of hemoglobin. In addition, it stimulates fibroblast growth, increases collagen formation, promotes more rapid growth of capillaries, and terminates lipid peroxidation. These actions of hyperbaric oxygen are useful in treating anaerobic infections that result in gas gangrene, as well as severe aerobic infections such as necrotizing fasciitis, malignant external otitis, and chronic refractory osteomyelitis. Hyperbaric oxygen can help preserve ischemic tissues and facilitates the rapid spread and arborization of new capillaries. It promotes healing in certain problem wounds. Adjunctive hyperbaric oxygen treatment is a new approach to the management of radionecrosis. Hyperbaric oxygen treatment reduces morbidity and mortality resulting from carbon monoxide poisoning. Protocols for hyperbaric oxygen therapy are at present mostly empirical; much additional research is needed to better define therapeutic indications.

Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation.

One hundred nine patients with long-bone fracture nonunion, chronic refractory osteomyelitis, or posttraumatic amputation were evaluated for the impact of chronic disability on quality of life, as measured by the Arthritis Impact Measurement Scale (AIMS) and the Psychosocial Adjustment to Illness Scale (PAIS). A self-administered PAIS for spouses assessed psychosocial adjustment of spouses or significant others. A final questionnaire ranked the reasons for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and both nonunion and amputation patients (p less than .05). The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients (p less than .05). Subscale analysis of AIMS scores revealed significant differences among the three groups in health perception and scale of orthopedic problem: osteomyelitis patients were more severely affected than nonunion or amputation patients. The PAIS detected no statistically significant difference in psychosocial adjustment of spouses of patients in the three population groups. The most common reason for continuing medical and surgical management of nonunion and osteomyelitis was expectation for cure. The amputee group chose ablation to avoid further treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation.

Neutropenia complicating parenteral antibiotic treatment of infected nonunion of the tibia.

Fifty patients with posttraumatic tibial nonunion complicated by chronic refractory osteomyelitis were treated with intravenous antibiotics. Fifteen patients (30%) experienced 18 episodes of leukopenia; seven of these patients became neutropenic and three became severely neutropenic. No patient became neutropenic prior to the 20th day of antibiotic therapy. The classic findings of fever, pruritus, maculopapular rash, and eosinophilia did not correlate with either the onset or the severity of the neutropenia. Neutropenia can develop precipitously. Prevention of neutropenia is difficult in a patient population receiving long-term antibiotic therapy. Regular monitoring of the white blood cell count and differential cell count minimizes the risk of developing prolonged, severe neutropenia with potential complications. No patient in this series had any serious or infectious complication secondary to neutropenia.

Analytic Reviews : Hyperbaric Oxygen Therapy

The physiological effects of hyperbaric oxygen extend beyond the elevation of oxygen concentration in body tissues, and clinical data is available to support its use in more than gas bubble diseases. Hyperbaric medicine is discussed within the context of its recognized mecha nisms of action. The experimental data and clinical ex perience for hyperbaric oxygen therapy are reviewed for the following conditions: clostridial myonecrosis, necrotizing soft-tissue infections, chronic refractory os teomyelitis, radiation necrosis, refractory cutaneous ul cerations, compromised skin grafts and flaps, crush in jury and acute peripheral ischemia, carbon monoxide poisoning, arterial gas embolism, decompression sick ness, and thermal burns. Risks associated with hyper baric oxygen therapy are discussed, and cost analysis data are noted for specific conditions.