Ilizarov bone transportation to treat tibial traumatic osteomyelitis of Cierny-Mader types III and IV

Abstract

Objective To discuss clinical outcomes of Ilizarov technique in the treatment of tibial traumatic osteomyelitis of Cierny-Mader types Ⅲ and Ⅳ.Methods From March 2008 to December 2012 we treated 47 patients with tibial traumatic osteomyelitis.They were 33 men and 14 women,aged from 18 to 61 years (average,35.9 years).According to the Cierny-Mader anatomical classification,the osteomyelitis was of type Ⅲ in 17 cases and of type Ⅳ in 30.Thirty-five patients had open fractures and 12 closed ones.Forty-one patients were complicated with sinus tract formation in the dead bone and plate exposure,and 17 patients with shortened varus and valgus.Thirty-one patients were complicated with skin and soft tissue defects at the anterior tibia.The areas of defects ranged from 4 cm × 3 cm to 16 cm × 8 cm.They were treated by resection of the lesion segments and Ilizarov bone lengthening combined with debridement,bone grafting and internal fixation.Bone lengthening distance,external fixation time,bone healing and functional recovery were recorded and analyzed with Spearman rank correlation statistics.Results The 47 patients were followed for 13 to 41 months (average,24.6 months).The average bone lengthening in this series was 6.4 cm,the external fixation time 232.2 days,the bone transport speed 12.6 d/cm,and the external fixation index 37.8 d/cm.Bony union was obtained in 46 patients and re-infection occurred in one.According to the modified Paley's criteria for bone healing,36 cases were excellent,9 good,one moderate and one poor,with an excellent to good rate of 95.7％.The functional recovery was rated as excellent in 24 cases,good in 16,moderate in 6 and poor in one,giving an excellent to good rate of 85.1％.The lengthening distance was negatively related to the bone healing and functional recovery levels(P ＜ 0.05) while the external fixation time was negatively related to the functional recovery (P ＜ 0.05).Conclusion The Ilizarov bone transport is an effective treatment for tibial traumatic osteomyelitis of Cierny-Mader types Ⅲ an Ⅳ. Key words: Osteomyelitis; Tibia; Ilizarov technique; Treatment outcome