Risk factors associated with infection recurrence of posttraumatic osteomyelitis treated with Ilizarov bone transport technique-a retrospective study of 149 cases

Abstract

Background: Post-traumatic tibial osteomyelitis is considered as complex clinical problem due to its unique characteristics such as prolonged course, multi-staged treatment and high recurrence rate. The purpose of this study is to identify and analyze the causes and risk factors associated with infection recurrence of tibial osteomyelitis treated with Ilizarov technique.

Methods: From January 2011 to January 2019, a total of 149 patients with post-traumatic tibial osteomyelitis treated with Ilizarov bone transport technique were included in this study. Demographic and clinical data were collected and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the recurrence or reinfection of post-traumatic tibial osteomyelitis after treated with Ilizarov bone transport technique.

Results: All included patients were successfully followed up with an average of 37.5 month (18-78 month), among them, 17 patients (11.4%) occurred with recurrence or reinfection of tibial osteomyelitis in which 2 cases were in distraction area and 15 cases in docking site. Among them, 5 patients were treated successfully with appropriate intravenous antibiotic, the remaining 12 patients were intervened by surgical debridement or bone grafting after debridement. Univariate analysis showed that Pseudomonas aeruginosa infection, bone exposure, number of previous operations (> 3 times), blood transfusion during bone transport surgery, course of osteomyelitis > 3 months, diabetes was associated with recurrence or reinfection of postoperative tibial osteomyelitis. According to the results of logistic regression analysis, Pseudomonas aeruginosa infection, bone exposure, and the number of previous operations (> 3 times) are risk factors for recurrence or reinfection of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique, with odds ratios (OR) of 6.055, 7.413, and 1.753, respectively.

Conclusion: The number of previous operations (> 3 times), bone exposure, and Pseudomonas aeruginosa infection are risk factors for infection recurrence of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique.

Keywords: Posttraumatic osteomyelitis; Recurrence; Risk factors;bone transport.

Fig. 1

A male patient with left tibia fracture caused by traffic accident and post-traumatic osteomyelitis after plate internal fixation.(A). X-ray film at 12 months after removal of the internal fixator showing tibia osteomyelitis; (B). Anteroposterior X-ray films on the day after radical debridement and installation of external fixation; (C) Anteroposterior X-ray films at 119 days after operation, showing bone contact was reached; (D). Lateral X-ray films at 11.5 months after operation shows good regenerate consolidation,and bone grafting at the docking site.(E). After 9 months removed external fixation, infection recurrence were located in the distraction region .The patient suffered refracture at the docking site at the same time, which were treated with debridement, antibiotic cement and extenal fixation.(F,G) Function recovery at 19 months after removal of external fixator