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Polymicrobial infection
6%
57/924
Use of external fixation
15%
143/924
Infection with Methicillin-resistant Staphylococcus aureus
4%
35/924
Metaphyseal infection
73%
670/924
Contralateral lower extremity amputation
1%
12/924
Select Answer to see Preferred Response
Success in the treatment of chronic tibial osteomyelitis is dependant on various factors including patient factors (immunocompetency of patient, nutritional status), injury factors (severity of injury as demonstrated by segmental bone loss), and infection factors (the extent and location of infection – metaphyseal infections heal better than mid-diaphyseal infections). Cierny’s article states that factors affecting prognosis and treatment include: residual foreign materials and/or ischemic and necrotic tissues, host compromise, inappropriate antibiotic coverage, and the lack of patient cooperation or desire. The second referenced article by Cierny reviews the significant increase in success over the last 20 years in treating infected tibial nonunions, due to pharmacological and technological advances. He reports an increase in limb salvage from 78% to 93% with modern protocols. Incorrect Answers: Answer 1: Polymicrobial infection portends a worse prognosis than a single organism. Answer 2: External fixation has not been shown to improve outcomes in chronic osteomyelitis. Answer 3: MRSA infections are a risk factor for poor outcomes. Answer 5: Contralateral extremity amputation increases the risk of poor outcomes.
2.7
(54)
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