Prevention and treatment of osteomyelitis after open tibia fractures

Abstract

Infection and chronic post-traumatic osteomyelitis of the tibia after open fracture are complex problems that cause significant morbidity and threaten the viability of a limb. Therefore, it is of utmost importance for the orthopaedic surgeon to understand both patient and treatment factors that modify the risk of developing these disastrous complications. Infection risk is largely based on severity of open injury in addition to inherent patient factors. Orthopaedic surgeons can work to mitigate this risk with prompt antibiotic administration, thorough and complete debridement, expedient fracture stabilization, and early wound closure. In the case osteomyelitis does occur, the surgeon should use a systematic multidisciplinary approach for eradication.

Keywords: infection; open tibia; osteomyelitis.

Figure 1.

The Cierny-Mader classification of osteomyelitis created with BioRender.com.

Figure 2.

Case of a 53-year-old patient who sustained a Gustilo IIIB open tibia fracture 2 years before presentation. The patient developed osteomyelitis of the distal third tibia. A, Initial radiographs. B, The entire infected segment of bone was removed, the prior hardware was removed, and exchange nailing was performed. The critical defect was filled with a PMMA antibiotic spacer. C, Six weeks later, the spacer was removed and filled with distal femur metaphyseal cancellous autograft mixed with allograft. D, Radiographs 6 months postoperatively show bony healing and consolidation. PMMA = polymethylmethacrylate.