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One-Stage Treatment of Osteomyelitis for Digital Salvage using an Antibiotic Eluting Methylmethacrylate Joint-Stabilizing Spacer
Leland H. Webb, MD; John T. Kidwell, MD; Raman C. Mahabir, MD, MSc; Anthony A. Smith, MD
Mayo Clinic, Phoenix, AZ

Introduction: Osteomyelitis of the digit is a challenging problem that can result in amputation particularly when the osteomyelitis involves the joint. The purpose of this retrospective study is to review 11 cases of osteomyelitis of the digit managed with a novel technique. Materials &
Methods: With IRB approval, we performed a retrospective review of 11 patients treated with placement of a joint-stabilizing, antibiotic eluting, methylmethacrylate spacer as a definitive one-stage treatment for digital osteomyelitis. The primary outcome was eradication of the infection[0] as defined by no recurrent infection at three months. Secondary outcomes included stabilization of the joint, functional status of the operated hand relative to individual goals, visual analog pain scale, wound characteristics, and radiographic outcomes. The patients were followed until resolution of infection and plateau in hand function.
Results: At a mean follow up of seven and a half months, all digits were successfully salvaged with the one-stage operation. Our data included patient ages ranging from 39 to 87 years old and involved either the distal interphalangeal, proximal interphalangeal or metacarpal phalangeal joints. Following intraoperative cultures, each patient was treated with broad spectrum intravenous antibiotic coverage. Antibiotic spacers eluted either tobramycin or vancomycin into the local area. No patient required removal of the spacer due to recurrent infection or joint instability and all patients regained a functional active range of motion. There were two minor complications: One patient experienced dysesthesia at the tip of the right middle finger that resolved with desensitization therapy. A second patient experienced a fracture of the spacer, but retained normal function and no further surgeries were required. In all subjects, the patientsí goals of function were achieved.
Conclusion: We present an innovative treatment plan for osteomyelitis of the digit using an antibiotic eluting methylmethacrylate spacer. In eleven consecutive cases we were able to salvage the digit with preservation of functional outcomes.


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