Posttraumatic Osteomyelitis Research Articles

Adipose-Derived Stromal Cells Are Capable of Restoring Bone Regeneration After Post-Traumatic Osteomyelitis and Modulate B-Cell Response.

Bone infections are a frequent cause for large bony defects with a reduced healing capacity. In previous findings, we could already show diminished healing capacity after bone infections, despite the absence of the causing agent, Staphylococcus aureus. Moreover, these bony defects showed reduced osteoblastogenesis and increased osteoclastogenesis, meaning elevated bone resorption ongoing with an elevated B‐cell activity. To overcome the negative effects of this postinfectious inflammatory state, we tried to use the regenerative capacity of mesenchymal stem cells derived from adipose tissue (adipose‐derived stem cells [ASCs]) to improve bone regeneration and moreover were curious about immunomodulation of applicated stem cells in this setting. Therefore, we used our established murine animal model and applicated ASCs locally after sufficient debridement of infected bones. Bone regeneration and resorption as well as immunological markers were investigated via histology, immunohistochemistry, Western blot, and fluorescence‐activated cell scanning (FACS) analysis and μ‐computed tomography (CT) analysis. Interestingly, ASCs were able to restore bone healing via elevation of osteoblastogenesis and downregulation of osteoclasts. Surprisingly, stem cells showed an impact on the innate immune system, downregulating B‐cell population. In summary, these data provide a fascinating new and innovative approach, supporting bone healing after bacterial infections and moreover gain insights into the complex ceremony of stem cell interaction in terms of bone infection and regeneration. stem cells translational medicine 2019;8:1084–1091

Is Hypercalcemia a Frequent Complication following Local Use of Calcium Sulfate with Antibiotics for the Treatment of Extremity Posttraumatic Osteomyelitis? A Preliminary Study.

Background Previous study had reported hypercalcemia as a frequent complication (20%) following local use of antibiotic-eluting calcium sulfate (CS) during treatment of periprosthetic joint infections (PJIs). However, whether this complication may occur in patients who receive local CS implantation for management of posttraumatic osteomyelitis (OM) remains unclear. Methods Between April 2016 and May 2017, we included 55 patients with extremity posttraumatic OM who received local antibiotic-loaded CS therapy. Serum calcium levels were detected preoperatively and on the 1st, 3rd, and 7th postoperative days (PODs). Comparisons were performed regarding serum calcium levels among the four time points and between two different CS volume groups (≤ 20 cc group and > 20 cc group). Additionally, potential associations were examined regarding CS volume and preoperative calcium level with postoperative calcium levels, respectively. Results Altogether 46 males and 9 females were included, with a median CS volume of 20 cc. Outcomes showed that prevalence of asymptomatic hypocalcemia was more frequent, with 16.4% before surgery and 60%, 53.8%, and 25% on the 1st, 3rd, and 7th PODs, respectively. Hypercalcemia was not found in any patients, at any time point. In addition, significant differences were identified regarding serum calcium levels among different time points, suggesting significantly decreased calcium levels on the 1st (P < 0.001) and 3rd PODs (P < 0.001) and back to near preoperative level on the 7th POD (P = 0.334). However, no statistical differences were observed regarding serum calcium levels between the two CS volume groups at any time points (P > 0.05). Moreover, no significant links were identified between CS volume and postoperative calcium levels (P > 0.05). Serum calcium levels on the 3rd (P = 0.019) and 7th PODs (P = 0.036) were significantly associated with the preoperative calcium level. Conclusions In contrast to what had occurred in PJI patients, asymptomatic hypocalcemia appeared to be more frequent in this cohort with posttraumatic OM. Hypercalcemia may be an infrequent complication before and after local CS use for the treatment of extremity posttraumatic OM.

Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures

BackgroundEarly diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity. AimThe objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery. Patients and methodsThis prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4). ResultsWe discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM. ConclusionsWe can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.

Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006\u20132016

BackgroundWar-wounded civilians in Middle East countries are at risk of post-traumatic osteomyelitis (PTO). We aimed to describe and compare the bacterial etiology and proportion of first-line antibiotics resistant bacteria (FLAR) among PTO cases in civilians from Syria, Iraq and Yemen admitted to the reconstructive surgical program of Médecins Sans Frontières (MSF) in Amman, Jordan, and to identify risk factors for developing PTO with FLAR bacteria.MethodsWe retrospectively analyzed the laboratory database of the MSF program. Inclusion criteria were: patients from Iraq, Yemen or Syria, admitted to the Amman MSF program between October 2006 and December 2016, with at least one bone biopsy sample culture result. Only bone samples taken during first orthopedic surgery were included in the analysis. To assess factors associated with FLAR infection, logistic regression was used to estimate odds ratio (ORs) and 95% confidence intervals (CI).Results558 (76.7%) among 727 patients included had ≥1 positive culture results. 318 were from Iraq, 140 from Syria and 100 from Yemen. Median time since injury was 19 months [IQR 8–40]. Among the 732 different bacterial isolates, we identified 228 Enterobacteriaceae (31.5%), 193 Staphylococcus aureus (26.3%), 99 Pseudomonas aeruginosa (13.5%), and 21 Acinetobacter baumanii (2.8%). Three hundred and sixty four isolates were FLAR: 86.2% of Enterobacteriaceae, 53.4% of Pseudomonas aeruginosa, 60.5% of S. aureus and 45% of Acinetobacter baumannii. There was no difference in bacterial etiology or proportion of FLAR according to the country of origin. In multivariate analysis, a FLAR infection was associated with an infection of the lower extremity, with a time since the injury ≤12 months compared with time > 30 months and with more than 3 previous surgeries.ConclusionsEnterobacteriaceae were frequently involved in PTO in war wounded civilians from Iraq, Yemen and Syria between 2006 and 2016. Proportion of FLAR was high, particularly among Enterobacteriaceae, regardless of country of origin.

MRI Diagnosis for Post-Traumatic Osteomyelitis of Extremities Using Conventional Metal-Artifact Reducing Protocols: Revisited

To assess the diagnostic power of MR imaging features for post-traumatic osteomyelitis (PTOM) of the extremities with metal implants using a 3.0-T machine with conventional metal-artifact reducing (MAR) protocols. Between December 2012 and September 2016, 261 consecutive patients underwent MRI for clinical suspicion of PTOM in the appendicular skeleton at our hospital. A total of 72 enrolled patients with metal implants were divided into two groups, one with surgical, histologic, or microbiologic proven to be PTOM, and the other proven not to be PTOM. Their MR images were reviewed by two musculoskeletal radiologists who qualitatively analyzed various findings regarding PTOM, and concluded diagnosis of PTOM or without PTOM for each patient. All MR images were obtained using conventional MAR protocols. The sensitivity, specificity, positive and negative predictive values, and accuracy of MR diagnosis by two observers were 55%/38%, 81%/93%, 67%/40%, 73%/78%, and 71%/71%, respectively. Among the findings, T1 low signal intensity, medullary location, confluent pattern, typical features (concurrence of T1 low signal intensity, medullary, and confluent patterns), heterogeneous or no enhancement, and cortical destruction were statistically significant by univariate analysis (p<0.05). Among these features, only medullary involvement was significant by multivariate analysis (p = 0.007). Medullary involvement and no enhancement pattern were significant by step-wise discrimination analysis. Interobserver correlation was moderate with a weighted kappa value of 0.512 (confidence interval: 0.3-0.723). The overall accuracy for diagnosis of PTOM of the extremities using 3.0-T MRI with conventional metal-artifact reduction parameters was 71%. The strongest diagnostic MR imaging feature was medullary involvement of T1 low signal intensity. PTOM of the extremities can be accurately diagnosed with a 3.0-T MR machine using conventional MAR protocols.

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art.

Osteomyelitis (OM) of the lower limb represents a large unmet global healthcare burden. It often arises from a contiguous focus of infection and is a recognized complication of open fractures or their surgical treatment, arthroplasty, and diabetic foot ulcers. Historically, this debilitating condition is associated with high rates of recurrence and secondary amputation. However, excellent long-term outcomes are now achieved by adopting a multidisciplinary approach with meticulous surgical debridement, skeletal and soft tissue reconstruction, and tailored antimicrobial treatment. This review focuses on the modern evidence-based management of post-traumatic OM in the lower limb from a reconstructive plastic surgery perspective, highlighting the latest developments and areas of controversy.

Выраженность биохимических изменений сыворотки крови в зависимости от степени трофических нарушений у больных посттравматическим остеомиелитом голени

Выраженность биохимических изменений сыворотки крови в зависимости от степени трофических нарушений у больных посттравматическим остеомиелитом голени

Assessment of interleukin-17 and interleukin-4 in blood serum in posttraumatic osteomyelitis of the mandible

Assessment of interleukin-17 and interleukin-4 in blood serum in posttraumatic osteomyelitis of the mandible

An uncommon case: feline tail post-traumatic osteomyelitis

Post-traumatic osteomyelitis (OM) is an uncommon event in cats, usually affecting distal phalanges of extremities. Tail injuries seldom cause bone infection, but often result in neural damage with subsequent tail paralysis, and occasionally in urinary/fecal incontinence. We present a case of old stray cat which developed post-traumatic tail OM, and endured it for years. It was an immuno-compromised, neglected, animal strongly infested with larvae of Aelurostrongylus abstrusus and oocistae of Isospora felis. Ultimately, it was treated by tail amputation, with without any health consequences. Relevance and novel information: This report describes the management and outcome of a rare and a life-threatening case of feline post-traumatic tail OM which was previously not reported in literature.

Postoperative extremity metallosteosynthesis complications

Aim. To carry out the qualitative analysis of metal implant, inserted into the bone, determine tactics for treatment of inflammatory process in the postoperative period of metallosteosynthesis.&#x0D; Materials and methods. The treatment of 1325 patients with the developing posttraumatic osteomyelitis of the upper and lower extremities in the Department of Complicated Traumatology of City Clinical Hospital № 6 and traumatology departments of Perm for 10 years (2004–2014) was analyzed.&#x0D; Results. Metallosis was observed in 227 (17.2 %) persons. Matallosis was manifested by suppuration and fistula formation in the region of screw 2–3 months after operative treatment of fracture in 177 (76.3 %) patients, and in 50 (27.7 %) patients – by acute purulent inflammatory process immediately after the surgery. In 34 (15 %) patients, computed tomography and MRI demonstrated metal bone impregnations. All these 227 (17.2 %) patients underwent elimination of metal constructions. The postoperative wounds after elimination of metal constructions healed primarily in 152 (66 %) patients. Secondary healing of the postoperative wounds was noted in 75 (44 %) persons. The long-term results were studied during 3 years in 189 (83 %) patients. The development of the postoperative osteomyelitic process, connected with late removal of metal construction, was registered in 8 (4.4 %) persons. False joint was formed in 1 (0.5 %) patient with tibial fracture. Positive long-term result was reached in 180 (95.2 %) persons.&#x0D; Conclusions. Timely diagnosis, correctly chosen technique of treatment permit to provide full restoration of the structure and function, and obtain positive medical and social rehabilitation in this category of patients.

Association between tumor necrosis factor-α and lymphotoxin α gene polymorphisms and susceptibility to extremity post-traumatic osteomyelitis in Chinese population

Objective To investigate the association between tumor necrosis factor-α(TNF-α)and lymphotoxin α(LTα) gene single nucleotide polymorphisms (SNPs) and susceptibility to extremity post-traumatic osteomyelitis in Chinese population. Methods We used SNaPshot genotyping method to detect genotypes of 6 TNF-α gene SNP sites (rs1799964, rs1800630, rs1799724, rs1800750, rs1800629 and rs361525) and 1 LTα gene SNP site of rs909253 in 189 patients with post-traumatic osteomyelitis and 200 healthy controls. Genetic models were applied to investigate the potential links between the above-mentioned SNPs and risks of developing post-traumatic osteomyelitis. Results Outcomes revealed that the frequency of mutant allele C of rs909253 in the patient group was statistically higher than that in healthy controls (54.23% versus 45.00%, P=0.010, OR=1.448, 95%CI 1.092~1.921). Significant correlations were found between rs909253 and risk of developing post-traumatic osteomyelitis by recessive model (CC versus CT+TT, P=0.012, OR=1.868, 95%CI 1.150~3.035) and homozygote model (CC versus TT, P=0.021, OR=2.016, 95%CI 1.111~3.658). The frequency of CC (29.63%) in the patient group was higher than that in the control group (17.50%). With regard to rs1800629 site of TNF-α gene, we only found that the frequency of mutant allele A (4.23%) in the patient group was statistically lower than that(7.75%) in the control group (P=0.040, OR=0.526, 95%CI 0.283~0.978). Conclusions LTα gene SNP site rs909253 may be linked with elevated risk of developing post-traumatic osteomyelitis in Chinese population. Mutant allele C may be a risk factor and people with genotype of CC may be a group at a higher risk of developing post-traumatic osteomyelitis in China. Key words: Osteomyelitis; Tumor necrosis factors; Case-control studies; Gene polymorphisms; Onset risk

Discussion on dealing skills of complex soft tissue problems in osteomyelitis treated by Ilizarov technique

To discuss skills for the treatment of complex soft tissue problems in osteomyelitis using Ilizarov techniques. The clinical data of 31 patients with complex soft tissue problems during the treatment of osteomyelitis with Ilizarov technique between January 2015 and June 2017 were retrospectively analyzed. There were 23 males and 8 females, with an age of 14-67 years (mean, 37.8 years). All the patients were post-traumatic chronic osteomyelitis, the disease duration was 12 days to 16 months (mean, 6.3 months). They went through 2-8 times surgeries (mean, 3.8 times). There were 29 cases of soft tissue insertion after bone grafting; 1 case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect; 1 case of the open tibial fracture postoperative infection, the skin defect of infection was more than that of bone defect. The soft tissue defect area was 4.5 cm×4.0 cm to 16.5 cm×8.5 cm. Soft tissue depression and insertion was corrected by subcutaneous insertion of Kirschner wire after slow elastic retraction. Soft tissue defects were gradually resolved through slow traction. All patients were followed up 6-24 months (mean, 11.5 months). All wounds healed by first intention, and skin graft and flap repair were not performed in the two stage. One case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect was treated with slow skin traction, no secondary suture was performed; no skin ulceration was found after walking for 3 months, and the feeling was slightly lower than normal. One case of soft tissue transverse traction wound completely covered, with no bone exposure and no obvious pigmentation of local soft tissue, the feeling was slightly lower than normal, the skin elasticity was worse than normal, and the color, temperature had no obvious abnormalities. There was no severe needle eye reactions in 29 patients with skin depressions corrected by Kirschner wire. Six cases of Kirschner wire showed elastic retraction and lacerate skin; 1 case of plantar skin traction had 2 times of exudation of the needle eye and local skin reddish phenomenon; the symptoms relieved when the traction needle was changed once, the traction was stopped for 1 week, the dressing was changed and antibiotics were used once. One patient with transverse traction had 3 times of pin-eye infection, and the treatment was completed after adjusting the traction device and symptomatic treatment. For most of the complex soft tissue problems in osteomyelitis, early and effective intervention with Ilizarov technique can be easily, economically, and effectively solved, which provides a new way for clinical treatment.

Posttraumatische Osteomyelitis: bessere Behandlungsergebnisse durch innovative Vakuumversiege‑lungstechnik mit Instillationstherapie

Posttraumatic Osteomyelitis: Improvement in Outcome by Negative Pressure Wound Therapy with Instillation Technique Abstract. Surgical treatment of post-traumatic (fistula) osteomyelitis can be difficult and is associated with an increased risk of later recurrence. Very often osteomyelitis is accompanied by a soft tissue (defective) wound. After surgical debridement, the use of the vacuum sealing technique can stimulate wound healing and improve local blood circulation. In particular, the introduction of the innovative instillation technique for wound sponges can increase the effectiveness of the treatment of the infection. By regularly rinsing the sponges with an antiseptic polyhexanide solution, the duration of treatment, the number of operations, the in-patient stay and the recurrence rate in this patient group can be statistically significantly reduced.

Septic Arthritis, Septic Bursitis, and Osteomyelitis

Infections of joints and bones are important causes of morbidity due to the potential for permanent injury to structures necessary for mechanical support and useful motion. The spectrum of disease is broad, with host factors, pathogen, site of infection, and comorbidities all influencing outcome. In some cases of bone infection, cure may not be possible, and the therapeutic goal becomes control. This review details the epidemiology, pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis of septic arthritis, septic bursitis, vertebral body osteomyelitis, pedal osteomyelitis in association with diabetes, and chronic posttraumatic osteomyelitis with union or malunion. This review contains 13 highly rendered figures, 16 tables, and 192 references.

Septic Arthritis, Septic Bursitis, and Osteomyelitis

Infections of joints and bones are important causes of morbidity due to the potential for permanent injury to structures necessary for mechanical support and useful motion. The spectrum of disease is broad, with host factors, pathogen, site of infection, and comorbidities all influencing outcome. In some cases of bone infection, cure may not be possible, and the therapeutic goal becomes control. This review details the epidemiology, pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis of septic arthritis, septic bursitis, vertebral body osteomyelitis, pedal osteomyelitis in association with diabetes, and chronic posttraumatic osteomyelitis with union or malunion. This review contains 13 highly rendered figures, 16 tables, and 192 references.

Presurgical localization of infected avascular bone segments in chronic complicated posttraumatic osteomyelitis in the lower extremity using dual-tracer PET/CT

BackgroundLocalizing and removing the infected sequestrum in long-standing trauma-related chronic osteomyelitis remains a clinical challenge. PET/CT with 18F-fluorodeoxyglucose (FDG-PET) has a high sensitivity for chronic osteomyelitis and 18F-sodium-fluoride PET/CT (NaF-PET) has a high specificity for identifying non-viable bone. Combining both, high signal on FDG-PET in the bone without signal on NaF-PET could potentially guide surgery to become more precise with curative intent.Eight patients with long-standing (average 22 years) posttraumatic (n = 7) or postoperative (n = 1) chronic osteomyelitis in the lower extremity and with multiple futile attempts for curative surgery were recruited in this prospective pilot study. FDG-PET and NaF-PET were performed within a week in between using standard scanning protocols. The most likely location of the culprit sequestrum was identified and was surgically removed. Based on perioperative tissue cultures, antibiotics were given for 6–8 months. Dual-tracer (FDG- and NaF-PET/CT) was performed again after 12 months to rule out persisting signs of infection.ResultsA likely culprit sequestrum could preoperatively be identified by dual-tracer PET in all eight cases and in four cases an additional sequestrum was identified at a location with no clinical sign of infection. The infected necrotic tissue was removed during surgery. Follow-up dual-tracer PET revealed no signs of persistent infection. All patients recovered with no clinical signs of recurrence for a follow-up of mean 4.5 (SD 1.3) years.ConclusionsDual-tracer PET/CT with FDG and NaF allows successful precise surgery with curative intent in patients with long-standing complicated posttraumatic chronic osteomyelitis with severely deranged anatomy.

Antimicrobial peculiarities of modified magnesium alloy in vitro

Infection complications after osteosynthesis happen in 5,3–75,4 % of cases, among them posttraumatic osteomyelitis — in 3–24 % after open and 1–7 % — after surgery of closed fractures. The main infectious agents of surgical site infection are Staphylococcus species.Objective: to assess antimicrobial activity of disintegration products of modified magnesium alloy ML-10 as for S. aureus.Methods: in the experiment we used modified magnesium alloy ML-10 with modulus of elasticity which is close to cortex bone surface (≈45 GPа) in the form of shavings (0,5 and 1 mg), discs (weight 125 mg, diameter 5 mm, height 3 mm) and cylinders (weight 750 mg, diameter 5 mm, length 18 mm). Shavings and discs were placed into test tubes with Mueller-Hinton broth (рН 7,4), and discs and cylinders — into Mueller-Hinton agar. As test microbial agent we used culture of standard reference S. aureus ATCC 25923 (American Type Culture Collection).Results: it was shown that products of disintegration of modified magnesium alloy ML-10 have bacteriostatic effect and significant antimicrobial activity as for test infection agent S. aureus ATCC 25923, they suppress its growth in liquid environment during three days. Such effect was conducted by products of disintegration of mentioned alloy due to electric and chemical reactions and creation of alkaline PH environment (from 7,4 to 9,6). Disintegration products of modified magnesium alloy ML-10 can diffuse in dense nutrient and suppress the growth of S. aureus.Conclusions: it was confirmed that modified magnesium alloy ML-10 can be used for implant production. There is unique possibility to prevent the growth of S.aureus which is the main infection agent of implant-associated infection.

Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis.

Background: We hypothesized that polymicrobial posttraumatic osteomyelitis (PTO) may be associated with worse outcomes when compared to monomicrobial PTO. We therefore attempted to show the outcomes and predisposing factors associated with polymicrobial PTO.Methods: A single-center case-control study was carried out from 2007 to 2012. The outcome variables analyzed were: the need for additional surgical and antibiotic treatments, rates of amputation, and mortality associated with the infection. Univariate and multivariable analyses using multiple logistic regression were performed to identify risk factors associated with polymicrobial PTO, and p < 0.05 was considered significant.Results: Among the 193 patients identified, polymicrobial PTO was diagnosed in 37.8%, and was significantly associated with supplementary surgical debridement (56.1% vs. 31%; p < 0.01), a higher consumption of antibiotics, and more amputations (6.5% vs 1.3%; p < 0.01). Factors associated with polymicrobial PTO in the multivariable analysis were older age (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01 to 1.03, p = 0.04), working in agriculture (OR = 2.86, 95% CI = 1.05 to 7.79, p = 0.04), open fracture Gustilo type III (OR = 2.38, 95% CI = 1.02 to 5.56, p = 0.04), need for blood transfusion (OR = 2.15, 95% CI = 1.07 to 4.32, p = 0.03), and need for supplementary debridement (OR = 2.58, 95% CI = 1.29 to 5.16, p = 0.01).Conclusions: PTO is polymicrobial in more than one-third of patients, associated with extra surgical and clinical treatment, and worse outcomes including higher rates of amputation.

Clinical application of vacuum sealing drainage combined with chymotrypsin in the treatment of post-traumatic mandibular osteomyelitis

This article introduces the combined application of vacuum sealing drainage (VSD) and chymotrypsin in the treatment of post-operative mandibular osteomyelitis. The lesion was washed by chymotrypsin (4000U) and saline (500 ml). VSD is effective in the treatment of traumatic mandibular osteomyelitis. This study investigates the effect of VSD combined with chymotrypsin in the treatment of patients with osteomyelitis after mandibular trauma. It is proved that it has a good effect in ensuring drainage, controlling infection and retaining internal fixation, and can create a good environment for fracture healing.

CELL-MEDIATED IMMUNITY IN PATIENTS WITH POSTTRAUMATIC LONG BONE OSTEOMYELITIS IN THE COURSE OF MANAGEMENT WITH THE ILIZAROV METHOD

Cell-mediated immunity parameters were studied in 26 patients (13 males, 13 females) aged 46 years (range: 39-51 years) with fistular type of chronic posttraumatic osteomyelitis of the humerus during the course of surgical treatment with the Ilizarov monofocal transosseous osteosynthesis. The study time-points were pre-surgery period and the following treatment stages: days 3, 7, 21 after osteosynthesis and day 1 after removal of the device. An obligatory criterion of inclusion was absence of postoperative complications and infection recurrence at least a year after removal of the apparatus. Control group were 30 healthy volunteers in the similar age (15 males, 15 females). Carriers of HCV, HIV, HBsAg and persons with concomitant somatic pathology that could affect the results of immunological study were not included. The study of subpopulation composition of the peripheral blood lymphocytes was carried out using laser flow cytometry. The parameters of cell-mediated immunity in patients with a fistular type of chronic posttraumatic osteomyelitis of the humerus were characterized by mild lymphopenia, increase in the number of cells of early and late activation of T lymphocytes (CD3 + CD25 + , CD3 + HLA-DR + ). Physiological response of the immune system to debridement of the purulent foci and transosseous osteosynthesis was normalization of the number of activated T-lymphocytes at the final stage of surgical treatment. In general, the dynamic changes of immunological indices were in favor of persistent arrest of the infection process and were confirmed by clinical observations.