UNASSIGNED: Calcium sulphate is a recent alternative for delayed antibiotic elution in infected bones and joints. The purpose of this study is to evaluate the use of antibiotic impregnated calcium sulphate (AICS) beads in the management of infected tibia and femur, with regards to patient outcomes and complication rates (including reinfection rate, remission rate and union rate).
UNASSIGNED: Searches of AMED, CINAHL, EMBASE, EMCARE, Medline, PubMed and Google Scholar were conducted in June 2020, with the mesh terms: \"Calcium sulphate beads\" or \"Calcium sulfate beads\" or \"antibiotic beads\" or \"Stimulan\" AND \"Bone infection\" or \"Osteomyelitis\" or \"Debridement\" AND \"Tibia\" or \"Femur\". Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of interventions (ROBINS-i) tool, and quality assessed via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria.
UNASSIGNED: Out of 104 relevant papers, 10 met the inclusion criteria for data extraction. Total infection remission was 6.8%, which was greater than that of polymethylmethacrylate (PMMA, 21.2%). Complication rates varied. The main issue regarding AICS use was wound drainage, which was considerably higher in studies involving treatment of tibia alone. Studies using PMMA did not experience this issue, but there were a few incidences of superficial pin tract infection following surgery.
UNASSIGNED: Where AICS was used, it was consistently effective at infection eradication, despite variation in causative organism and location of bead placement. Wound drainage varied and was higher in papers regarding tibial cases alone.

Background: Osteomyelitis is a complex disease. Treatment involves a combination of bone resection, antimicrobials and soft-tissue coverage. There is a difficulty in unifying a classification system for long bone osteomyelitis that is generally accepted. Objectives: In this systematic review, we aim to investigate the classification systems for long bone osteomyelitis that have been presented within the literature. By doing this, we hope to elucidate the important variables that are required when classifying osteomyelitis. Methods: A complete search of the Medline, EMBASE, Cochrane and Ovid databases was undertaken. Following exclusion criteria, 13 classification systems for long-bone osteomyelitis were included for review. Results: The 13 classification systems that were included for review presented seven different variables that were used for classification. Ten of them used only one main variable, two used two variables and one used seven variables. The variables included bone involvement (used in 7 classification systems), acute versus chronic infection (used in 6), aetiopathogenesis (used in 3), host status (used in 3), soft tissue (used in 2), microbiology (used in 1) and location of infected bone (used in 1). The purpose of each classification system could be grouped as either descriptive (3 classification systems), prognostic (4) or for management (4). Two of the 13 classification systems were for both prognostic and management purposes. Conclusions: This systematic review has demonstrated a variety of variables used for classification of long bone osteomyelitis. While some variables are used to guide management and rehabilitation after surgery (e.g., bone defect, soft tissue coverage), others were postulated to provide prognostic information (e.g., host status). Finally, some variables were used for descriptive purposes only (aetiopathogenesis). In our view and from today\'s perspective, bone involvement, antimicrobial resistance patterns of causative micro-organisms, the need for soft-tissue coverage and host status are important variables to include in a classification system.