Abstract
Twenty cases of osteomyelitis following intramedullary nailing of the tibial shaft fracture were managed with a prospective treatment protocol comprising intramedullary reaming debridement, antibiotic-bead depot, external skeletal fixation, microvascular muscle flap and early cancellous bone grafting. The follow-up period ranged from 25 to 48 months (average, 34.3 months). Pseudomonas aeruginosa (37.5%) and staphylococcus aureus (20.8%) were the organisms most commonly involved. There were 8 united and 12 ununited fractures after reaming debridement surgery. Nineteen infections were initially arrested by one debridement. One infection was arrested by two sequential debridements. All 12 ununited fractures were stabilized by Hoffmann unilateral external fixation until the fracture healed. The time spent in external fixation ranged from 3 to 7 months (average, 5.2 months). Early cancellous bone grafting was successfully accomplished for 9 ununited fractures with major debridement bone loss. The average union time of the 9 fractures with bone grafting was 7.2 months (range, from 6 to 8 months). We believe that this treatment protocol gives a predictable and rapid recovery. The complications were infection recurrence in two cases at the old tibial shaft fracture sites, minor pin tract infection of Hoffmann external fixators in two cases, and stiffness in two ankles and one knee.
Résumé
Vingt cas d’ostéomyélite après enclouage centromédullaire pour fracture de la diaphyse tibiale furent traités de manière prospective comprenant un débridement alésage intramédullaire, un dépot de billes antibiotiques, un fixateur externe, une couverture par un lambeau musculaire libre et greffe osseuse le plus rapidement possible. Le recul d’observation fut de 25 à 48 mois (34,4 mois en moyenne). Pseudomonas aeruginosa (37,5 %) et Staphylocoque aureus (20,8 %) furent les germes les plus fréquemment impliqués. Il y eut 8 consolidations et 12 non consolidation des fractures après débridement et alésage. Dix-neuf infections ont été guéries par débridement. Une infection a nécessité 2 débridements séquentiels. Les 12 fractures non consolidées ont été stabilisées par fixateur externe de Hoffman jusqu’à consolidation, la durée s’étale de 3 à 7 mois (moyenne de 5,2 mois). La greffe osseuse a permis la consolidation de 9 fractures présentant une perte osseuse importante à la suite du débridement. Le temps de consolidation fut en moyenne de 7,2 mois (étendu de 6 à 8 mois). Nous pensons que ce protocole de traitement permet une guérison effective et rapide. Les complications sont la récurrence de l’infection dans 2 cas, une douleur mineure sur l’axe d’une broche de fixateur dans 2 cas, et l’enraidissement de 2 chevilles et d’un genou.
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European Bone and Joint Infection Society Meeting, München, Germany, October 7–9, 1993
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Ueng, WN., Shih, CH. Management of infected tibial intramedullary nailing using an organized treatment protocol. Eur J Orthop Surg Traumatol 5, 151–155 (1995). https://doi.org/10.1007/BF02716261
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DOI: https://doi.org/10.1007/BF02716261