Management of Osteomyelitis-Induced Massive Tibial Bone Defect by Monolateral External Fixator Combined with Antibiotics-Impregnated Calcium Sulphate: A Retrospective Study

Abstract

Aim: The present study is aimed at evaluating the effect of combined treatment on massive bone defect using radical debridement, antibiotic calcium sulphate, and monolateral external fixator.

Methods: 35 patients with tibial osteomyelitis received radical debridement, and during surgery antibiotics-impregnated calcium sulphate was used for filling the bone defect. Monolateral external fixator was used to manage the bone defect of average 95 (61-185) cm.

Results: Bone union was achieved in 34 patients (97.1%) with no reinfection. One case was presented with reinfection and further debridement was conducted. The average time for the utility of external fixation was 17 (7-32) months, and external fixation index (EFI) was 1.79 mon/cm. The mean follow-up duration after surgery was 33.7 (21-41) months. 19, 13, and 3 patients got excellent, good, and fair bone results, respectively. Meanwhile, functional results were excellent, good, fair, and poor in 13, 15, 6, and 1 patient. The most common complication was pain (100%) and superficial pin-tract infection (22.8%). Delayed maturation was incurred in 2 patients.

Conclusion: Our study reveals that radical debridement combined with antibiotics-impregnated calcium sulphate can suppress infection, and distraction osteogenesis using monolateral external fixators plays an effective role in managing osteomyelitis-induced massive tibial bone defect.

Figure 1

Case 17, a 33-year-old man with chronic osteomyelitis of the tibia. The left figure is the preoperative clinical photograph. The right figure is the preoperative anteroposterior X-ray photograph.

Figure 2

The left figure was the resection of infected bone segment when radical debridement was conducted. The right figure was the anteroposterior X-ray photograph taken few hours after surgery, and antibiotic-impregnated calcium sulphate was demonstrated to be filled in the bone defect.

Figure 3

The figures in the left, middle, and right position showed the anteroposterior X-ray photographs taken about 1, 8, and 13 months after surgery.

Figure 4

Anteroposterior and lateral X-ray photographs taken 3 months after the external fixation was removed.

Figure 5

Techniques to place antibiotics-impregnated calcium sulphate. Please note that both bone marrow cavity (the left figure) and bone defect (the right figure) should be filled.