Optimizing Surgical Planning Using 18F-FDG PET-CT in Appendicular Chronic Osteomyelitis: Insights from 84 Patient...

The surgical management of chronic osteomyelitis is essential. Determining the extent of the infection can be challenging. This study investigates the role of 18F-FDG PET/CT as a preoperative planning tool to guide adequate surgical debridement and improve clinical outcomes.

This is a retrospective study of prospectively collected data that was conducted on 84 patients (66 males, 18 females; mean age 32 ± 14.9 years, range 7-73) with confirmed appendicular chronic osteomyelitis treated between 2019 and 2024. All patients underwent 18F-FDG PET/CT imaging and surgical Geographic adequate debridement based on PET/CT findings. Follow-up was maintained for a minimum of 1 year (mean 27.9 ± 10.2 months; range 12-60 months), monitoring for infection recurrence.

Half the patients presented with infected united or hematogenous osteomyelitis; the other half with infected non-union. The femur and tibia were the most frequently affected sites. Postoperative infections following closed fractures internal fixation (44%), open fractures (37%), and hematogenous (19%). PET/CT scans identified clear resection margins in all cases, soft tissue collections in 23.8%, and sequestrum in 67.9%. According to the Cierny-Mader classification, 40% were diffuse (Type IV), 40% localized (Type III), 18% intramedullary (Type I), and 2% superficial (Type II). The mean SUVmax was 6.69 ± 3.63 at the infection site and 1.45 ± 0.81 at the contralateral limb. Microbiological cultures revealed no growth in 17.9% of cases; among the 82.1% positive cultures, 56% were gram-positive (predominantly MRSA), 34% gram-negative (mainly Klebsiella), and 10% polymicrobial. Various reconstruction techniques were utilized post-debridement. Only three patients (3.6%) experienced infection recurrence within the first year.

Integrating PET/CT into the surgical planning for chronic osteomyelitis may enhance outcomes and reduce recurrence. PET/CT offers clear margins, delineates soft tissue collections and sequestrum, and is not affected by metalwork. Among the 84 patients studied, the success rate reached 96.4% at a mean 27.9 month follow-up.