L-shaped corticotomy with bone flap sliding in the management of chronic tibial osteomyelitis: surgical technique and clinical results

Teng-fei Lou,Yi-min Chai,Xiao-fan Yin,Gen Wen,Chun-yang Wang,Pei Han

doi:10.1186/s13018-019-1086-0

Abstract

BackgroundWe described the use of the technique of L-shaped corticotomy with bone flap sliding to treat chronic osteomyelitis of the tibia in eight patients and presented the preliminary results.MethodsL-shaped corticotomy with bone flap sliding was performed in eight patients between 2007 and 2014. All patients had chronic tibial osteomyelitis involving the anterior tibial cortex with intact and healthy posterior cortex. The size of bone defects following sequestrectomy and radical debridement was 8.1 cm on average. One patient required a latissimus dorsi flap. The mean follow-up period was 34.1 months. The functional and bone results were evaluated at the time of the latest follow-up.ResultsComplete eradication of infection and union of docking sites were achieved in all patients. Functional results were judged excellent in five patients and good in the rest three patients. Bone results were graded as excellent in all cases. The mean external fixation time was 169.9 days and external fixation index was 21.2 days/cm. Pain was the most common complaint that we faced during lengthening. Pin tract infections were observed in four patients, and mild transient stiffness of ankle joint was observed in three patients.ConclusionsWe have found this technique to be safe and effective, significantly diminishing the external fixation index. The earlier removal of the external fixator may result in increased patient comfort, a reduced complication rate, and a rapid and convenient rehabilitation.

Highlights

Chronic osteomyelitis of the tibia, which can be post-operative or secondary to open fracture [1], remains a considerable challenge to treat in clinical practice
Chronic osteomyelitis typically results in necrosis of soft tissues and bone to a variable extent
Between 2007 and 2014, eight consecutive patients with chronic osteomyelitis only involving the anterior tibial cortex were treated using the technique of L-shaped corticotomy with partial bone flap sliding at our hospital (Table 1)

Summary

Introduction

Chronic osteomyelitis of the tibia, which can be post-operative or secondary to open fracture [1], remains a considerable challenge to treat in clinical practice. Chronic osteomyelitis typically results in necrosis of soft tissues and bone to a variable extent. The necrotic bone forms infected foci for hosting pathogens. In order to create a vascular and viable environment, the first step of managing a chronic osteomyelitis is appropriate radical debridement requiring excision of all infected bone and soft tissue [3]. There are several different surgical techniques reported to treat chronic osteomyelitis, including antibiotic cement rod [4], vascularized bone graft [5], bone grafting [6], and Ilizarov methods [7]. We described the use of the technique of L-shaped corticotomy with bone flap sliding to treat chronic osteomyelitis of the tibia in eight patients and presented the preliminary results

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Conclusion