Drug injection often results in soft tissue infections of the upper extremity. The purpose of this study was to determine the distinct bacteriologic features of soft tissue abscesses in injecting drug abusers in order to provide guidelines for optimal empiric antibiotic therapy.

Admissions to the musculoskeletal infection ward at our institution from 1993 to 2005 were screened to identify patients with a history of injecting illicit drugs and a diagnosis of a soft tissue abscess. Eight hundred fifty-five patients met these criteria and were included in this retrospective study. There were 638 male and 217 female patients with a mean age of 41.5 years (18 to 75 years).

In the 694 patients with positive cultures the most common organism was Staphylococcus aureus, identified in 359 patients (52%). A progressive increase in the prevalence of ORSA was observed; ORSA comprised 5% of Staphylococcus aureus infections in 1999, 50% in 2001, 56% in 2003, and 82% in 2005. Microaerophilic Streptococcus was present in 37% of culture-positive cases and other anaerobes in 10%. Infections were monomicrobial in 366 of 694 patients (53%) and polymicrobial in 328 of 694 patients (47%).

Staphylococcus aureus is the most common pathogen in soft tissue abscesses in injecting drug abusers with an increasing proportion of ORSA. In addition to surgical decompression of abscesses, broad-spectrum empiric antibiotic therapy may be necessary.

Intramedullary infection is a challenging problem and management usually includes removal of the infected hardware and reaming of the medullary canal.

The purpose of this study is to describe a new technique for canal debridement and evaluate its efficacy in the treatment of posttraumatic osteomyelitis of the tibia and femur.

This retrospective study included 11 patients (10 male and 1 female, mean age: 42 years) with posttraumatic osteomyelitis of the tibia (n=8) or femur (n=3). Surgical treatment consisted of debridement, implant removal, and reaming of the medullary canal with the RIA (Reamer Irrigator Aspirator) device. All procedures were performed by a single surgeon with a standardised technique. Reaming of the canal was performed with one pass of the RIA. Following reaming, the RIA was used for irrigation of the medullary canal with 10 liters of fluid.

At a mean follow-up time of 9 months (6 to 13 months) there was no recurrence of osteomyelitis. Complications included one partial loss of a flap, one refracture of a tibia following an auto versus pedestrian accident, and external fixator pin tract infections in one patient.

The RIA device allows for reaming under simultaneous irrigation and aspiration, which may minimise the residual amount of infected tissue in the medullary canal. The disposable reamer head is always sharp, in contrast to standard reamers, which may reduce the thermal effects of reaming on the adjacent bone. In addition, the RIA allows delivery of fluid throughout the length of the medullary canal, thus facilitating irrigation. The RIA device is useful alternative for debridement of intramedullary infections of the tibia and femur.

Aim of the study: The outcomes of 50 consecutive patients with chronic periprosthetic total hip arthroplasty infections were evaluated based on a staging system developed at the authors’ institution. The staging system includes three categories: infection type (acute versus chronic), systemic host grade, and local extremity grade.

Methods: The initial treatment plan was a two-stage resection followed by reimplantation if clinically indicated. Treatment was modified for each patient according to how the patient responded to initial debridement. The average follow-up was 23.2 months (range, 0–74 months). Of the 50 patients, 29 had reimplantation with a total hip arthroplasty (58%), 17 patients had permanent resections (34%), and four patients had amputations (8%). Five patients died (10%). Fifteen patients had muscle flap transfers into the hip for soft tissue coverage.

Results: Significant correlations were seen with the staging system and outcome parameters. Patients who were very medically ill were far more likely to die or have their leg amputated. Conversely, healthier patients were more likely to have successful reimplantation. A strong correlation was seen with a compromised local wound and the need for muscle. ap transfer. Complication rates were strongly related to worsening medical condition and a worsening local wound.

Conclusion: Based on these results, a staging system for periprosthetic infection is a useful tool that with additional refinement will provide more objective evaluation of treatment methods for periprosthetic hip infection in the future.