Application of antibiotic cement-coated locking plates in induced membrane technique for treating post-traumatic tibial osteomyelitis

Abstract

Objective To investigate the clinical outcome of post-traumatic tibial osteomyelitis treated by induced membrane technique combined with the antibiotic cement-coated locking plate. Methods A restrospective case series analysis was made on 71 cases of post-traumatic tibial osteomyelitis treated by induced membrane technique from September 2014 to September 2014. There were 55 males and 16 females, aged 18-60 years(mean, 37.4 years). Mean length of bone defect following debridement was 4.5 cm(range, 4-11 cm). Antibiotic cement-coated locking plates were used to provide the stability of the bone defects after one-stage debridement. Bone grafting and exchanging the plates with ntramedullary nails were done during the second-stage surgery. Parameters were monitored dynamically after operation to evaluate infection recurrence and bone healing, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), clinical features(sinus formation, redness and swelling, warmth and pain) and X-ray films of the involved limbs. Results All patients were followed up for 13-25 months (mean, 19.5 months). There was no sign of recurring infection and CRP and ESR were normal in all cases after the first stage surgery. However, four cases (6%) had recurrent infection with sinus exudates and their CRP and ESR were abnormal after the second stage surgery, and further treatments were carried out on these patients. Follow-up showed bony union in all patients within mean 5.5 months (range, 4-6 months). Conclusion Induced membrane technique with antibiotic cement-coated locking plates for treatment of post-traumatic tibial osteomyelitis can shorten bone healing time and decrease infection recurrent rate without obvious impact on osteogenic activity. Key words: Osteomyelitis; Fracture fixation, internal; Induced membrane technique