Table 3.
Management and Outcomes of Military Personnel with and without Osteomyelitis of the Upper Extremity Long Bones, No. (%)
| Total (N=160) | Osteomyelitis Cases (N=64) | Controls (N=96) | P-value | |
|---|---|---|---|---|
| First orthopaedic implant | <0.001 | |||
| External fixation | 77 (48.1) | 42 (65.6) | 35 (36.5) | |
| Internal fixation | 47 (29.4) | 9 (14.1) | 38 (39.6) | |
| None | 36 (22.5) | 13 (20.3) | 23 (24.0) | |
| Any external fixation of upper extremity | 86 (53.8) | 47 (73.4) | 39 (40.6) | <0.001 |
| Any internal fixation of upper extremity | 119 (74.4) | 52 (81.3) | 67 (69.8) | 0.139 |
| Level of care for initial stabilization1 | 0.004 | |||
| Within combat zone | 65 (51.2) | 36 (69.2) | 29 (38.7) | |
| LRMC (Germany) | 13 (10.2) | 4 (7.7) | 9 (12.0) | |
| U.S. hospital | 49 (38.6) | 12 (23.1) | 37 (49.3) | |
| Presence of foreign body at fracture site2 | 0.182 | |||
| Fragment with orthopaedic implant | 59 (37.1) | 26 (41.3) | 33 (34.4) | |
| Fragment only | 22 (13.8) | 5 (7.9) | 17 (17.7) | |
| Orthopaedic implant only | 68 (42.8) | 26 (41.3) | 42 (43.8) | |
| No foreign body | 10 (6.3) | 6 (9.5) | 4 (4.2) | |
| Time to definitive orthopaedic surgery | 0.005 | |||
| Final stabilization <30 days | 86 (53.8) | 27 (42.2) | 59 (61.5) | |
| Final stabilization 30 to <60 days | 4 (2.5) | 2 (3.1) | 2 (2.1) | |
| Final stabilization 2 - 6 months | 14 (8.8) | 6 (9.4) | 8 (8.3) | |
| Final stabilization >6 months | 23 (14.4) | 17 (26.6) | 6 (6.3) | |
| No orthopaedic implant | 33 (20.6) | 12 (18.8) | 21 (21.9) | |
| Median days to radiographic union (IQR)3 | 83 (57-132) | 96 (65-136) | 76 (54-120) | 0.106 |
| Time to radiographic union3 | 0.076 | |||
| <6 months | 97 (87.4) | 36 (81.8) | 61 (91.0) | |
| 6 to <9 months | 10 (9.0) | 6 (13.6) | 4 (6.0) | |
| 9 to <12 months | 2 (1.8) | 0 | 2 (3.0) | |
| ≥12 months | 2 (1.8) | 2 (4.5) | 0 | |
| Bone graft2 | 0.046 | |||
| Allograft only | 14 (8.8) | 7 (11.1) | 7 (7.3) | |
| BMP only | 2 (1.3) | 1 (1.6) | 1 (1.0) | |
| Autograft | 11 (6.9) | 7 (11.1) | 4 (4.2) | |
| Combination | 3 (1.9) | 3 (4.8) | 0 | |
| Unspecified graft | 7 (4.4) | 1 (1.6) | 6 (6.3) | |
| Antibiotic beads used4 | 41 (27.2) | 27 (45.8) | 14 (15.2) | <0.001 |
| Vancomycin | 33 (21.9) | 23 (39.0) | 10 (10.9) | |
| Prophylactic antibiotics | 0.639 | |||
| Cefazolin | 30 (18.8) | 12 (18.8) | 18 (18.8) | |
| Other antibiotics | 9 (5.6) | 5 (7.8) | 4 (4.2) | |
| Data not available5 | 121 (75.6) | 47 (73.4) | 74 (77.1) |
BMP – bone morphogenetic proteins; IQR – interquartile range; LRMC – Landstuhl Regional Medical Center
Level of care information is missing for 33 patients (12 cases and 21 controls). Percentages based on total minus missing.
Information is unknown for 1 osteomyelitis case patient. Percentages based on total minus unknown.
Data excludes patients with transhumeral/transradial amputations and missing time to radiographic union (total = 111; osteomyelitis cases = 44; controls = 67). Percentages based on total minus unknown.
Antibiotic bead use information is unknown for 5 cases and 4 controls. Percentages based on total minus unknown.
Antibiotic use within combat support hospitals prior to arrival at Landstuhl Regional Medical Center is unknown