DOS 2019

170 · DOS Abstracts Osteomyelitis in patients with diabetes mellitus, one- stage revision protocol Karl Viktor Strange Guldagger, Hans Gottlieb, Magnus Petur Bjarnason Obinah Department of Orthopaedic Surgery, Herlev; Department of Plastic and recon- structive surgery, Herlev Background: Osteomyelitis(OM) are challenging to treat, especially in patients with diabetes mellitus(DM) Purpose / Aim of Study: We report outcome after one-stage surgery with antibiotic loaded biocomposite(ALB) for management of OM in patients with DM Materials and Methods: We report a consecutive series of 45 patients with OM and DM, treated at one institution, operated by a few surgeons, managed by a multidisciplinary team, using a one-stage revision protocol. The treatment protocol includes surgical debridement, tissue sampling, dead- space manage- ment using an ALB, direct closure when possible and 6 weeks of postoperative empirical antibiotic therapy, adjusted based on culturing. This series includes all patients with OM and DM operated at our institution according to this protocol, from March 2016 – September 2018 Findings / Results: A total of 45 patients were followed-up (FU) by chart re- view with a minimum FU of 6 months, mean FU was 13.7 months. Mean age was 68,8 years (45 to 92). A total of 34 (76%) patients were males and eleven (24%) females. Twelve patients (27%) were ASA class 2, 30 (67%) ASA class 3, 3 (7%) ASA class 4. Thirty-nine patients (87%) had cardiac issues ranging from essential hypertension to heart failure. Three patients had renal insufficiency and two were in dialysis. Four patients (8%) died within 3 months of surgery. The suspected cause of OM in our series, was soft tissue infection in 37 cases (82%) and surgical management of a closed fracture in 5 cases (11%), while the remaining three cases were suspected to be caused by hematogenous spread, insertion of a prosthesis or previous osteomyelitis in the local area. Following the primary procedure, during our follow-up period, 29 patients (64%) had not required further surgical revision, 9 patients (20%) had subsequent soft- tissue or bone revision and 10 patients (22%) had been amputated. Of the 10 am- putations performed, 6 were due to exposed bone or infection in the overlying soft-tissue. Of note, the number of comorbidities was higher in the group of amputated patients compared to non-amputated, 9 patients (90%) were ASA class 3 and 1 was class 2 (10%) Conclusions: An acceptable outcome was obtained considering the highly co- morbid population with a high 3-month mortality of 8% 126.