Technique of Papineau in the Management of Chronic Osteomyelitis in a Low Setting Area. A 12 Years’ Experience

Abstract

Introduction: Chronic osteomyelitis, a bone infectious pathology is difficult to treat. The authors report their experience in a series of patients treated in a low-income country.

Methods: We report a prospective study of 53 patients suffering of chronic osteomyelitis for a long time, covering our experience between January 1998 to December 2010 at the Kinshasa University Hospital in central Africa. We used the technique described by Papineau with success, until the consolidation of the bones and the drying up of the wounds.

The following elements were analyzed and taken into account: age and sex of the patients, sites involved, germs, surgical technique, length of stay in the hospital and estimated cost of the treatment.

Result: The majority of patients were between 26 and 35 years old with extremes between 15 and 80 years old, with 34 males and 19 females with a sex ratio of 1.7/1. Upper limb was involved with 7 humerus, 6 radius, 6 cubitus and the lower limb with 14 femurs and 20 tibias. Staphylococcus aureus was the germ most found in cultures from dead bone from intraoperative technique. Stay in hospital on average was 17 weeks for upper limb and 28 weeks for the management of lower limb injuries. The average cost for the treatment was estimated for 700 to 800 dollars.

Conclusion: Chronic osteomyelitis is a tenacious condition for long-term evolution, but it is nevertheless encouraging to dry up foci, which were the toughest challenges for orthopedics and plastic surgeons. In a low setting region, the management of the disease remains a condition with a high economic cost and it is absolutely useless to begin a Papineau treatment if the patients do not have enough money.