Gastrocnemius muscle flap with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone graft for the phase I treatment of localized osteomyelitis after tibial plateau fracture surgery

Weiwei Ruan,Menglu Li,Bingyuan Lin,Qiaofeng Guo

doi:10.1186/s13018-021-02496-1

Abstract

PurposeTo investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery.MethodsFrom July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications.ResultsAll patients were followed up for 24–60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87).ConclusionUsing a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase I treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.

Highlights

Tibial plateau fractures are intra-articular fractures that are mostly secondary to high-energy injuries
The traditional treatment of chronic osteomyelitis is a staged treatment regimen represented by antibiotic bead chain implantation, with a two-stage autologous cancellous bone graft [7,8,9]
Patient information Based on the Cierny-Mader classification, there were 20 cases of type A and 15 cases of type B

Summary

Introduction

Tibial plateau fractures are intra-articular fractures that are mostly secondary to high-energy injuries. Since the infection recurrence rate as well as the amputation risk are high, the clinical efficacy of osteomyelitis after tibial plateau fracture is still unsatisfactory [5, 6]. The traditional treatment of chronic osteomyelitis is a staged treatment regimen represented by antibiotic bead chain implantation, with a two-stage autologous cancellous bone graft [7,8,9]. Until this century, the emerging masquelet technique [10] becomes a new Petunia for staging treatment due to its simple operation, few complications, low infection rate, rapid postoperative bone healing process, and early weight-bearing time [11, 12].

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