Short Term Results of Treatment of Osteomyelitis in the Diabetic Foot with a Synthetic Bone Graft Sustitute

CATEGORY: Diabetes; Midfoot/Forefoot INTRODUCTION/PURPOSE: The aim of the study was to evaluate short term results of osteomyelits of the diabetic foot treated with cerament METHODS: 16 diabetics with a mean age of 61.6 years underwent surgical therapy of infection of the foot using Cerament and a 6- week resistance-based antibiotic therapy. The surgical procedures included bony debridement, temporary vacuum therapy, arthrodesis or resection arthroplasty. Postoperative treatment included clinical investigation and MRI control of the affected foot. The foot ulcerations were classified preoperatively. Pathological assessments of osteomyelitis were made. The recurrence rates of osteomyelitis and ulcerations, the number of surgical procedures, and the complication rates were determined. RESULTS: A foot ulcer was found preoperatively in 56.3% of the patients. 10 patients (62.5%) were diagnosed with chronic osteomyelitis, 6 with florid osteomyelitis. The number of necessary surgical procedures was 2 in 8 patients (50%), 4 in 4 patients (25%), 3 in 3 patients (18.8%) and 1 in 1 patient (6.3%). After a median followup of 8.6 months, no recurrence of osteomyelitis could be detected in 13 patients (81.3%). With regard to foot ulcerations, the ulcer healed completely in 15 patients (93.8%). One patient had ulcer recurrence. The complication rate was 18.8% (3 patients). The statistical analysis also showed that the patient's age had no significant influence on the recurrence rate of osteomyelitis and ulceration.Furthermore, there were significant differences between patients with chronic and florid osteomyelitis. Patients with chronic osteomyelitis were more likely to have osteomyelitis recurrences, while patients with a proven florid infection were more likely to have ulcer recurrences. CONCLUSION: The osteomyelitis treatment of the diabetic foot shows good results in terms of the recurrence rates of osteomyelitis and foot ulceration. With regard to the differentiated consideration of the results in chronic and florid osteomyelitis, additional investigations are necessary.