Background: Bedside Blind Bone Biopsy (B4) performed by a diabetologist has been recently shown as a reliable tool to manage antibiotherapy in case of Diabetic Foot Ulcer (DFU) with suspected osteitis. Here, we evaluated the performance of B4 compared to the conventional procedure (Basic Bone Biopsy, B3) performed either by surgery or interventional radiology.
Method: A bicentric, observational, retrospective study was conducted in two different diabetes departments. B4 was performed by a diabetologist from December 2015 to August 2018 (32 months) in Center A. B3 was performed by a surgeon or an interventional radiologist from September 2013 to august 2018 (61 months) in Center B. The primary end point was complete healing with Exclusive Medical Treatment (EMT: offloading, wound care±antibiotherapy) at 3 months. The secondary end points were the rates of contaminations and sterile Bone Biopsies (BB).
Results: Among 1112 patients with diabetes mellitus (DM) admitted with foot ulcer, 146 consecutive patients (13%) were presented with clinically and/or radiological suspicion of osteitis and consequently with an indication of BB. B4=97/415 DFU (23%), B3=49/697 DFU (7%, surgery n=33/49 [67.4%], radiology n=16/49 [32.6%]). Patients characteristics were as followed and similar between the 2 groups: males (74.7%), mean age (68.6±12.2 years), mean duration of DM (18.4±10,9 years), mean glycated hemoglobin (8.1±2,1%). No statistical difference was observed for mean delay between time of BB decision and procedure (B4 16.2±13,3 days, B3 13.6±9,3 days, p=0.65), contaminations (B4 10%, B3 10.4%, p=0.86) and sterile BB (B4 36%, B3 22.9%, p=0.10). The rate of patients with complete healing with EMT at 3 months was similar between the two groups (B4 44.8%, B3 28.6%, p=0.12).
Conclusion: B4 is a simple and valid diagnostic procedure to manage DFU with suspected osteitis. It results to comparable healing rate than more sophisticated and expensive procedures.
F. Féron: None. L. Potier: Advisory Panel; Self; Merck Sharp & Dohme Corp. Consultant; Self; Sanofi. G. Péan de Ponfilly: None. D. Gauthier: None. A. Munier: None. E. Lecorche: None. N. Grall: None. M. Laloi-Michelin: None. F. Mercier: None. T. Vidal-Trécan: Board Member; Self; Novo Nordisk Inc. M. Marre: Advisory Panel; Self; Servier. Board Member; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S. J. Riveline: Board Member; Self; Abbott, Lilly Diabetes, Novo Nordisk Inc. Consultant; Self; Novo Nordisk Inc. Research Support; Self; Air Liquide, Amgen Inc. Speaker's Bureau; Self; Abbott, Lilly Diabetes, Sanofi. J. Gautier: None. R. Roussel: Advisory Panel; Self; Merck Sharp & Dohme Corp., Sanofi. Consultant; Self; Abbott, AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Physiogenex. Research Support; Self; Janssen Pharmaceuticals, Inc. J. Kevorkian: None.