Ilizarov technique and windowing continuous irrigation of the medullary cavity to treat chronic lower limb osteomyelitis following intramedullary nailing

Abstract

Objective To investigate surgical treatment of chronic osteomyelitis of the lower limb following intramedullary nailing by Ilizarov technique and windowing continuous irrigation of the medullary cavity. Methods From January 2012 to December 2014, we treated 12 patients with chronic osteomyelitis of the lower limb following intramedullary nailing. They were 9 men and 3 women, 26 to 47 years of age (average, 36 years). The surgical procedures included windowing continuous irrigation of the medullary cavity followed by debridement, external fixation, and bone transport or bone lengthening after metaphysis osteotomy. There were 4 cases of femoral infection and 8 of tibial infection. Irrigation was carried on after operation for an average of 4 weeks (range, 3 to 5 weeks). Wound healing, bone union and joint function of lower extremity were followed up postoperatively. Results All patients were followed up for 8 to 20 months (average, 10.3 months). All wounds healed without recurrent infection. Five patients had pin tract infection which responded to change of dressing in 4 cases and removal of Kirschner wire. Intramedullary infection did not reoccur. Fine bone union was achieved in all after an average bone lengthening or bone transporting of 5.2 cm (from 4 to 7 cm). The healing indexes ranged from 34 to 69 d/cm (average, 52.7 d/cm). The fixation time ranged from 7 to 17 months (average, 13 months). Limb isometry was achieved in all but one case whose affected limb was 2 cm shorter because of undue stop of bone lengthening. Joint function of the lower extremity was basically normal in all. Conclusion The chronic osteomyelitis of the lower limb following intramedullary nailing can be cured by Ilizarov technique and windowing continuous irrigation of the medullary cavity. Key words: Bone diseases, infectious; External fixators; Bone lengthening; Ilizarov technique