A Survey of Orthopedic Surgical Management of Pressure Ulcer-Related Pelvic Osteomyelitis

Abstract

Pressure-ulcer related pelvic osteomyelitis is managed with little high-quality evidence. We undertook an international survey of orthopedic surgical management, covering diagnostic parameters, multidisciplinary input, and surgical approaches (indications, timing, wound closure, and adjunctive therapies). This identified areas of consensus and disagreement, representing a starting point for future discussion and research.

Keywords: decubitus ulcer; pelvic osteomyelitis; pressure ulcer; sacral osteomyelitis.

Figure 1.

Questionnaire responses. A, Responses to “What relative degree of priority do you attach to the following parameters when diagnosing pressure-ulcer related pelvic osteomyelitis?” Comparisons were made using Mann-Whitney test. B, Responses to “How often do you receive input from the following specialties in the management of patients with pressure ulcer–related pelvic osteomyelitis?” and “How often do you obtain surgical input from a plastic surgeon during the index procedure?” C, Responses to “Rank the relative influence of each variable on identifying which patients are likely to benefit from surgical intervention” (respondents could assign the same rank to multiple variables). D, Responses to “Rank the relative influence of each variable on the optimal timing of surgical intervention” (respondents could assign the same rank to multiple variables). E, Responses to “How often do you use the following adjunctive surgical therapies?” F, Responses to “Select whether there is a role for the following primary definitive surgical wound management techniques.” G, Responses to “What antimicrobial approach would you use in the following scenarios?” (“Longer” was defined as >2 weeks, and “shorter” as ≤2 weeks.) H, Responses to “Which modality of infection specialist input do you most commonly receive?” and “Which modality of infection specialist input would you prefer to receive?” Responses were compared using Fisher exact test (for telephone vs bedside). Vertical dotted line represents mark n = 21 on the x-axis. The denominator is n = 41 responses for all panels, except H, where n = 40. Abbreviations: MR, magnetic resonance; OM, osteomyelitis; OT, occupational therapy; SPC, suprapubic catheter; SSTI, skin and soft-tissue infection; TVN, tissue viability nursing.