Induced membrane technique combined with locking compression plate for the treatment of tibia infected defects

Abstract

Objective To observe the clinical efficacy of induced membrane technique combined with locking compres-sion plate as an external fixator for the treatment of tibia infected defects. Methods Data of 107 patients with tibia infected de-fects who were treated by induced membrane technique combined with locking compression plate (LCP) as an external fixator in our department from June 2013 to May 2015 were retrospectively analyzed. Among them, 62 cases’ LCP were replaced with intra-medullary nail during second stage (internal fixation group), while 45 cases kept their LCP (external fixation group). There were 52 males and 10 females in internal fixation group, aged from 18-61 (average, 39.6), and their bone defects ranged from 3-17 cm (av-erage, 6.93 cm). 15 cases were type Ⅲ and 47 cases were type Ⅳ according to Cierny-Mader classification. 9 cases were suffered from hematogenous osteomyelitis and 53 cases suffered from trauma. 15 cases located in proximal tibia, 28 cases in middle tibia and 19 cases in distal tibia. There were 45 cases in external fixation group, aged from 18-65 (average, 41.3), and their bone de-fects ranged from 5-12 cm (average, 7.12 cm). 13 cases were type Ⅲ and 32 cases were type Ⅳ according to Cierny-Mader classi-fication. 6 cases were suffered from hematogenous osteomyelitis and 39 cases suffered from trauma. 12 cases located in proximal tibia, 19 cases in middle tibia and 14 cases in distal tibia. Results All 107 patients have been successfully followed up for 18-40 months (23.5 in average). There were 20 patients (18.7%) encountered with a second debridement before grafting because of in-fection recurrence and culture positive was verified in 10 cases. 101 cases acquired bone union, including 58 cases in internal fixa-tion group and 43 cases in external fixation group. Average radiographic bone union time was 6.2 and 6.9 months in internal fixa-tion group and external fixation group respectively. Nonuinon was observed in 6 cases (internal fixation group 4 cases, external fix-ation group 2 cases), with nonuion rate of 6.5% (4/62) and 4.4% (2/45). Infection reccurrence was found 3 cases in internal fixation group and 2 cases in external fixation group, with infection reccurence rate of 4.8% (3/62) and 4.4% (2/45) respectively. There were 5 cases observed pin track infection and 6 cases with pin track loosening in external fixation group. Conclusion Locking compression plate combined with induced membrane technique in the treatment of tibia infected defects can achieve a good clini-cal efficacy despite the complication of pin-track loosening and infection, unfavorable to the reconstruction of grafting bone. In in-ternal fixation group, both radiographic bone union and clinical bone union were shorter comparing with external fixation group. So, intramedullary nail is a better choice of induced membrane technique during the second stage. Key words: Infection; Wounds and injuries; External fixators; Tibia