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Malignant Transformation in Chronic Osteomyelitis: Recognition and Principles of Management

Panteli, Michalis MD, MRCS; Puttaswamaiah, Ravindra MBBS, MS; Lowenberg, David W. MD; Giannoudis, Peter V. MB, MD, FRCS

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: September 2014 - Volume 22 - Issue 9 - p 586–594
doi: 10.5435/JAAOS-22-09-586
Review Article

Malignant transformation as a result of chronic osteomyelitis represents a relatively rare and late complication with a declining incidence in the modern world. For most patients, the interval between the occurrence of the original bacterial infection and the transformation to malignant degeneration is several years. The diagnosis of malignant transformation in a chronic discharging sinus requires a high index of clinical suspicion. Wound biopsies should be obtained early, especially with the onset of new clinical signs such as increased pain, a foul smell, and changes in wound drainage. Squamous cell carcinoma is the most common presenting malignancy. Definitive treatment is amputation proximal to the tumor or wide local excision, combined with adjuvant chemotherapy and radiation therapy in selected patients. Early diagnosis may sometimes allow for treatment consisting of en bloc excision and limb salvage techniques. However, the most effective treatment is prevention with definitive treatment of the osteomyelitis, including adequate débridement, wide excision of the affected area, and early reconstruction.

From the Academic Department of Trauma and Orthopaedic Surgery, Leeds Teaching Hospitals, University of Leeds, West Yorkshire, UK (Dr. Panteli), the Department of Orthopaedic Surgery, SPARSH Hospital for Advanced Surgeries, Bangalore, India (Dr. Puttaswamaiah), the Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA (Dr. Lowenberg), and the Academic Department of Trauma and Orthopaedic Surgery, Leeds Teaching Hospitals, University of Leeds, NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, West Yorkshire, UK (Dr. Giannoudis).

Dr. Lowenberg or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Stryker; serves as a paid consultant to Stryker and Ellipse Technologies; and serves as a board member, owner, officer, and committee member of the Foundation for Orthopaedic Trauma. Dr. Giannoudis or an immediate family member has received royalties from Biomet; is a member of a speakers’ bureau or has made paid presentations on behalf of Synthes, Medtronic Sofamor Danek, and Olympus Biotech; serves as a paid consultant to Synthes and Olympus Biotech; serves as an unpaid consultant to Amgen; has received research or institutional support from DePuy, Synthes, and Pfizer; and serves as a board member, owner, officer, or committee member of the Orthopaedic Trauma Association, the British Trauma Society, the British Orthopaedic Association, the European Federation of National Associations of Orthopedics and Traumatology, and the Orthopaedic Trauma Association. Neither of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Panteli and Dr. Puttaswamaiah.

© 2014 by American Academy of Orthopaedic Surgeons
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