Single-stage procedures for treatment of traumatic patellar osteomyelitis: A retrospective study of 21 patients

Abstract

IntroductionWe herein report on a series of 21 patients with traumatic patellar osteomyelitis treated by single-stage surgery, and discuss the specific application of single-stage procedures for traumatic patellar osteomyelitis. MethodsWe retrospectively reviewed the medical records of 21 patients with traumatic patellar osteomyelitis treated in our hospital from January 2010 to April 2018. In a single-stage surgery, aggressive debridement was performed together with application of a tissue flap, especially a gastrocnemius flap (for repair of skin/soft tissue defects and treatment of extensor mechanism defects), and internal refixation of the patellar fracture. The knee joint was exercised early after surgery. Long-term follow-up was performed to evaluate the recurrence of osteomyelitis according to clinical and laboratory signs of infection and to measure the active knee range of motion (ROM). ResultsSingle-stage wound treatment was successful in 20 of 21 patients. Treatments included radical debridement together with tissue flap for repair of soft tissue and extensor mechanism defects, and internal refixation of patellar fractures. 14 patients were treated with gastrocnemius flaps. One patient developed recurrent wound infection, which healed after reoperation. At a mean follow-up of 8 ± 2.63 years (range, 3.2–11.4 years), none had developed recurrence. Six patients had nearly full knee ROM (0°–105° to 0°–146°), whereas 11 patients had impaired knee mobility (ROM, 0°–90° to 0°–65°), 3 patients had knee joint stiffness with a ROM of 0°, and 1 patient had knee flexion contracture with a ROM of 78°–130° ConclusionsSingle-stage surgical treatment consisting of various surgical techniques was an acceptable treatment for traumatic patellar osteomyelitis, allowing early exercise of the knee joint. The osteomyelitis did not recur, and most patients’ knee ROM was restored to a certain extent, excluding patients with severe damage to the patellar articular surface and inactive functional exercise.