Case studies and clinical papers: Musculoskeletal infections

Chronic draining sinus with Serratia in left ankle

69-year-old patient endured fifteen surgeries prior to presenting with chronic draining sinus. He was hospitalized and cultures tested positive for Serratia.

Transform osteomyelitis in diabetic foot

67-year-old male with type 2 diabetes and BMI of 37 presented with osteomyelitis and interphalangeal joint destruction to his left hallux.

Osteomyelitis caused by Group B Streptococcus and MRSA

73-year-old female with osteomyelitis caused by Group B Streptococcus and MRSA infection.

Transform infected humerus

44-year-old female presented with persistent and severe pain of the right arm. She had a history of infection following a nailing of the humerus 15 years ago.

Osteomyelitis caused by MRSA

40-year-old male with osteomyelitis caused by MRSA infection. Presented with drainage, failure of fixation and non-union 6 months after the initial ORIF calcaneus due to a 20ft fall.

Transform infected revision arthroplasty

Infected total knee replacement 2 years after primary procedure.

Transform infected trauma

Infected femoral nail and non-union of left femur with persistent discharging wounds proximally and distally.

Transform infected revision arthroplasty

35-year-old male presented with recurrent periprosthetic infection after complex hinged total knee replacement (TKR), performed 1 year ago, to treat severe post-traumatic knee osteoarthritis.

Transform osteomyelitis in diabetic foot

A 67-year-old male patient with Type 2 diabetes presented with a 1 year history of a right foot ulcer and symptoms of infection with osteomyelitis caused by Staphylococcus aureus.

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Proximal humeral fractures: The role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates

K. Somasundaram , C.P. Huber, V. Babu, H. Zadeh West Middlesex University Hospital NHS Trust, Department of Orthopaedics, Isleworth, Middlesex, UK

Purpose: A study to analyse the results of our surgical technique for the treatment of proximal humeral fractures and fracture dislocations using locking plates in conjunction with calcium sulphate bone-substitute augmentation and tuberosity repair using high-strength sutures.
Results: It was found that the use of locking plates, calcium sulphate bone substitute and tuberosity repair with high-strength sutures to be a safe and reliable method of internal fixation for complex proximal humeral fractures and fracture-dislocations. Furthermore, the use of the extended deltoid-splitting approach was found to be safe and to provide excellent exposure facilitating accurate reduction for fixation of the fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations.

The influence of third body damage with bone void fillers on the wear of UHMWPE

Cowie RM, Carbone S, Aiken S, Cooper JJ, Fisher J, Jennings LM. Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds, UK Biocomposites Ltd, Staffordshire, Keele, UK.

Purpose: In this study, damage to cobalt chrome plates caused by third body particles from bone cement and the bone void fillers was assessed. This was followed by wear tests of UHMWPE against the plates using a 6 station multi-axial pin on plate rig.

Results: It is evident that third body particles from bone void fillers or bone cement can scratch cobalt chrome counter faces, however no damage could be measured from STIMULAN. It was also determined under the wear test conditions used, to increase wear of UHMWPE, the surface damage must be severe with scratches requiring a lip height of over 2 μm.

A simple acoustic technique to assess the setting time of antibiotic loaded calcium sulphate

Laycock PA, Brayford MJ, Cooper JJ. Product Development. Biocomposites Ltd, Keele, Staffordshire, UK.

Purpose: Calcium sulfate hemi-hydrate when mixed with water results in the formation of a solid precipitated calcium sulfate dihydrate. Many factors affect the timing of this reaction, hence the need to quantify set times. This work developed a new simple acoustic technique to measure the setting times of a calcium sulfate bone cement loaded with different antibiotic mixes.

Results: A new simple acoustic test has been developed and used to assess the effect of different antibiotic additions on the setting time of a ‘rapid cure’ calcium sulfate bone cement (STIMULAN). This technique gives ‘absolute’, reproducible and consistent results and can be used with very small quantities of cement.

Assessing the influence of third body damage to articulating surfaces with bone void fillers

Purpose: Third body particles such as those from bone cements and bone void fillers when trapped between articulating surfaces can accelerate wear of arthroplasty materials leading to premature failure. In this two phase study the damage to cobalt chrome (CoCr) by PMMA bone cement, STIMULAN and a competitor calcium sulfate material was investigated. Damage simulation was evaluated using pin on disk testing and compared to that of control samples.

Results: Phase 1 damage simulation showed that STIMULAN resulted in no third body damage - causing no significant damage to cobalt chrome. Phase two results showed no additional damage to CoCr disks as a result of the STIMULAN, with results comparable to negative controls, where no third body material is present.