Abstract
BackgroundAlthough various methods have been introduced, the management of chronic tibial osteomyelitis remains a challenge. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis.MethodsForty-two patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received the treatment method mentioned above were included in the study. The infection remission rate, recurrence rate, complications rate, and bone healing rate were respectively analyzed.ResultsWith a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients pain, limitation of movement, sinus tracts, topical redness, and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed minor but acceptable discomfort in affected limbs. Five patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-ray examination, bone losses caused by local debridement were generally repaired, though the shape of the tibia was not well-restored to its initial form in 17 limbs. No fracture was recorded during follow-up.ConclusionLocal debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.
Highlights
Various methods have been introduced, the management of chronic tibial osteomyelitis remains a challenge
Chronic tibial osteomyelitis is defined as a long-term infection of the tibia and characterized by low-grade inflammation with sequestrum or fistulous tract [1]
Once established chronic tibial osteomyelitis, patients are prone to suffere from a variety of disastrous complications, such as pathological fracture, delayed healing or nonunion, or even major amputation, significantly reducing individual’s quality of life
Summary
Various methods have been introduced, the management of chronic tibial osteomyelitis remains a challenge. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis. According to anatomic osseous involvement [4], Cierny et al primarily divided chronic osteomyelitis into four types: medullary (type I), superficial (type II), localized (type III), and diffused (type IV), and further classified patients into three groups: healthy patients (group A), compromised patients (group B), and patients who were too weak to receive surgery (group C), based on the physiologic status of patients. Attributing to the limited involvement, localized tibial (Cierny-Mader (C-M) type III) osteomyelitis is not as complicated as the diffused one (type IV), but still owning its characteristics. In the aspect of surgical management, local debridement without segmental bone resection as the standard surgical management allows the restoration of a healthy enough bone, which avoids the massive bone loss and tedious secondary reconstruction to restore the length of the tibia [5, 6]
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