Microsurgical techniques combined with bone transportation for osteomyelitis following open fracture on the leg

Abstract

Objective To evaluate the efficacy of microsurgical techniques combined with bone transportation for osteomyelitis following open fracture on the leg. Methods From April 2007 to April 2016, 25 patients with osteomyelitis caused by severe open injury on the leg were treated at Orthopaedic Department, General Hospital of Rocket Force. They were 22 men and 3 women, aged from 19 to 65 years (average, 36.5 years). Their open injury was located at upper tibia in 6 cases, at middle tibia in 6 and at lower tibia in 13. Eight patients received internal fixation with plate and 17 unilateral external fixation. By the Cierny-Mader classification, their chronic osteomyelitis was of type Ⅲ in 14 cases and of type Ⅳ in 11. The tibial defects after excision of infectious segment ranged from 5 to 14 cm in length (average, 8.8 cm). After infectious tissues were removed, antibiotic bone cement chains were inserted into the defects. The open wounds were covered with microsurgical pedicled or free flaps. Bone transportation with unilateral external fixation was used to deal with the bone defects after removal of the infectious bone. Results Bone infection was controlled in the 25 patients. The rate of infection control after one debridement procedure was 76.0% (19/25), and that after 2 debridement procedures was 24.0% (6/25). Flap repair led to early closure of the open wounds. The successful rate of wound closure after one operative procedure was 84.0% (21/25), and that after secondary operation was 16.0%(6/25). Bony union of tibial defects was achieved in all the 25 patients with no recurrence of osteomyelitis. The patients were followed up for 18 to 36 months (average, 24.6 months). Re-fracture happened in one case and was treated with another operation. Bone union time starting from bone transportation ranged from 8 to 18 months (average, 10.5 months). Time for external fixation ranged from 12 to 20 months (average, 18.4 months). Conclusion For osteomyelitis caused by severe open injury on the leg, microsurgical techniques can be used to repair open wounds and bone transportation to reconstruct bone defects after removal of infectious bone. Key words: Fractures, open; Osteomyelitis; Surgical flaps; Bone transportation