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Radiographic Osteomyelitis in Xylazine-Associated Upper Extremity Wounds: A Retrospective Case Series
Parker H Johnsen, MD; Joseph G Bartolacci, MD PhD; Katharine T Woozley, MD
Cooper University Hospital, Camden, NJ
Introduction:
Xylazine, an increasingly common adulterant in illicit opioids including fentanyl, has been associated with severe soft tissue necrotic wounds. The lesions are often impressive, prompting a comprehensive workup to evaluate the extent of the wound, including advanced imaging. The prevalence of osteomyelitis and the value of advanced imaging in the workup of xylazine-associated wounds has not been described. We present a series of 39 patients with radiographic imaging for xylazine-associated upper extremity wounds, describe the rate of osteomyelitis, identify risk factors, and propose recommendations for workup of these complex wounds.
Materials and Methods:An electronic health record query was performed for all hospital admissions due to xylazine-associated upper extremity wounds at an urban tertiary care hospital over a 7 year period. Keywords included intravenous drug use, xylazine, and tranq. 39 patients who underwent radiographic imaging as part of their workup were identified. The rate of radiographically identified osteomyelitis was evaluated. Demographics, laboratory findings, and surgical complications were compiled and analyzed. Continuous variables were assessed using a Welch Approximation two-tailed T-test, and discrete variables using Chi squared tests. A p-value <0.05 was considered significant.
Results:
41% of patients with radiographic imaging for xylazine-associated wounds had osteomyelitis. Patients with osteomyelitis were significantly more likely to smoke tobacco (85% vs 15%, p = 0.003), and had a lower BMI (22.6 vs 26.1, p = 0.038). Hepatitis C was comorbid in nearly half of patients with osteomyelitis, however did not reach statistical significance (p = 0.08).
1 patient (3.6%) was found to have osteomyelitis on advanced imaging (CT or MRI) that was not identified on radiographs. Laboratory markers of inflammation and infection (WBC and platelet counts) were elevated in 72.7% of patients with radiographic evidence of osteomyelitis, however laboratory studies were less specific than radiographs as a diagnostic tool. The presence of osteomyelitis was associated with increased complications in patients who underwent surgical intervention (p < 0.0001). 19 patients underwent surgery, 10 (53%) experienced a complication, of which 7 (70%) had osteomyelitis prior to surgery. Complications included skin graft failures, osteocutaneous graft failure, and recurrent infections.
Conclusions:
A large percentage of patients with xylazine-associated upper extremity wounds have osteomyelitis that can be identified on plain radiographs. Our results show there is limited advantage in obtaining advanced imaging to evaluate for osteomyelitis, and that radiographic osteomyelitis is associated with a higher rate of surgical complications.
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