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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 9, 1243-1248.
doi: 10.1302/0301-620X.91B9.21768  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Closed double-lumen suction irrigation in the management of chronic diaphyseal osteomyelitis

LONG-TERM FOLLOW-UP

B. C. Caesar, BSc(Hons), MBBS, FRCSEd (Trauma & Orth), Specialist Registrar1; R. L. Morgan-Jones, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon2; R. E. Warren, FRCPath, Consultant Bacteriologist3; R. H. Wade, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon4; P. J. Roberts, BSc(Hons), DipASM, MBBS, FRCS(Orth), Consultant Orthopaedic Surgeon4; and J. B. Richardson, MBChB, FRCS, Professor of Orthopaedics1

1 Robert Jones and Agnes Hunt Orthopaedic Hospital, Hospital NHS Trust, Oswestry, Shropshire SY10 7AG, UK.
2 University Hospital of Wales, Heath Park, Cardiff, Wales CF14 4XW, UK.
3 Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire SY3 8XQ, UK.
4 University of North Staffordshire Trust, The Royal Infirmary, Princes Road, Stoke-on-Trent, Staffordshire ST4 7LN, UK.

Correspondence should be sent to Mr B. C. Caesar; e-mail: ben_caesar{at}hotmail.com

Between November 1994 and June 1999, 35 patients referred to our Problem Fracture Service with chronic diaphyseal osteomyelitis were treated using a closed double-lumen suction irrigation system after reaming and arthroscopic debridement of the intramedullary canal. This is a modified system based on that of Lautenbach.

Between June and July 2007 the patients were reviewed by postal questionnaire and telephone and from the case notes. At a mean follow-up of 101 months (2 to 150), 26 had no evidence of recurrence and four had died from unrelated causes with no evidence of recurrent infection. One had been lost to follow-up at two months and was therefore excluded. Four had persisting problems with sinus discharge and one had his limb amputated for recurrent metaplastic change.

Our results represent a clearance of infection of 85.3% (29 of 34), with recurrence in 11.8% (4 of 34). They are comparable to the results of the Papineau and Belfast techniques, but with considerably less surgical insult to the patient.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General