ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Is 18 F-FDG PET-CT-guided geographic debridement superior to conventional debridement in appendicular chronic osteomyelitis? a retrospective comparative cohort study.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDetermining the surgical extent of chronic osteomyelitis and fracture-related infection (FRI) remains challenging. Adequate resection margins prevent recurrence; however, no standardised preoperative tool objectively defines resection borders.
objectiveTo compare PET‑CT-guided surgical planning versus the local standard‑of‑care imaging pathway (predominantly plain radiographs, with selective CT or MRI in a minority of patients) for chronic limb osteomyelitis and FRI outcomes.
methodsRetrospective comparative cohort study of 126 patients treated 2019-2024. Group 1: 84 patients underwent 18 F-FDG PET-CT imaging and map-based geographic debridement. Group 2: 42 patients received surgery after local standard‑of‑care imaging pathway (predominantly plain radiographs, with selective CT or MRI). PRIMARY OUTCOME: infection recurrence at 12 months. Multivariable logistic regression controlled for confounders.
resultsPET-CT group achieved 3.6% recurrence versus 16.7% in the conventional group (p = 0.011), representing 78.5% relative risk reduction and a number-needed-to-treat of 8. Critically, the PET-CT cohort had significantly worse baseline complexity: 3.3-fold longer infection duration (43.1 vs. 13.1 months, p < 0.001) and 3.6-fold more prior surgeries (2.48 vs. 0.69, p < 0.001). Multivariable analysis confirmed PET-CT-guided surgery as an independent protective factor (OR 0.19, 95% CI 0.05-0.72, p = 0.015). PET-CT drew the resection margins in all cases, soft-tissue collections in 23.8%, and sequestra in 67.9%.
conclusionsIn this retrospective comparative study, PET-CT may enable objective, adequate geographic debridement, bridging radical and conservative approaches. Superior outcomes despite treating more complex infections may support PET-CT as a preoperative planning modality, demonstrating potential clinical and cost-effectiveness benefits. (Therapeutic study - retrospective comparative cohort). LEVEL OF EVIDENCE: III (Therapeutic study - retrospective comparative cohort).
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