Chronic bone infections / limb preservation

Chronic bone infections usually develop after open, contaminated fractures. Treatment is a challenge for an interdisciplinary team of surgeons and infectious disease specialists. Patients are often sent to us for a second opinion because they have been told that amputation of the limb is the only way to stop the infection. We use every medically sensible option to preserve the affected limb.

For a bone fracture to heal

• the supporting surfaces must be clean and vital and
• be immobilized and
• be covered by perfused tissue and
• the germs present must be treated with the right antibiotics for a sufficiently long time.

a ) In order to effectively treat the existing infection with antibiotics, it is often necessary to remove foreign material (e.g. screws, plates) and dead parts of the bone. These are not supplied with blood and thus block the accessibility of the pathogens present in the tissue for the antibiotics.

b) However, as the fracture has usually not yet healed stably during the infection, plates, screws and dead bone parts cannot be removed without replacement for stabilization.

c) If a soft tissue defect has also occurred as a result of severe crushing of the soft tissue in the course of the accident that caused the fracture, and bone with or without metal is exposed, this must be covered by tissue that is supplied with blood.

d ) Bone biopsies must be taken and used to test the correct antibiotics for treating the germs found.

Free vascularized bone grafts are an option for therapy that provides a suitable material for stabilization, which is supplied with blood and can therefore deliver the antibiotics to the infected tissue. They are taken from another part of the body and fitted into the defect. The bone to be transplanted is removed with a supplying vascular branch, which is microsurgically reconnected to the blood circulation at the recipient site. The transplanted bone is thus supplied with blood and heals while being shielded against the germs present by the circulating antibiotics. If necessary, the bone can also be removed with a piece of skin and/or muscle to cover a soft tissue defect. The fracture can then be repaired with stabilizing osteosynthesis material (e.g. plates, screws).

Colleagues from other hospitals are also welcome to discuss cases with us via teleconsulting. In our regular colloquia for septic bone surgery, we discuss the case reports sent to us together with colleagues from orthopaedics, traumatology and infectiology and make a recommendation for further treatment. Please send your request (with X-ray images, bacteriology and, if applicable, surgical reports) to Prof. Dr. Schaefer's office.

Karin Holzinger
karin.holzinger@usb.ch
Phone +41 61 265 73 00

If you would like to contact us directly as a patient, you are welcome to make an appointment for a consultation.

Make an appointment:

Tel. +41 61 265 73 00