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. 2025 Apr 16;14(7):103555.
doi: 10.1016/j.eats.2025.103555. eCollection 2025 Jul.

Uniportal Endoscopic Intramedullary Debridement for the Management of Tibial Osteomyelitis

Tun Hing Lui  1 , Ka Kin Cheung  1 , Hon Chun Chong  1
Affiliations

Uniportal Endoscopic Intramedullary Debridement for the Management of Tibial Osteomyelitis

Tun Hing Lui et al. Arthrosc Tech. .

Abstract

Chronic osteomyelitis is characterized by the presence of asequestrum, intramedullary abscess, and fistulous tracts. Bone endoscopy provides a minimally invasive approach to drain the intramedullary abscess and remove the dead and infected tissues under direct endoscopic visualization. The purpose of this Technical Note is to describe the details of uniportal endoscopic intramedullary debridement for management of chronic osteomyelitis of the metaphyseal region of tibia. This approach can reduce the number of bone portals needed. However, proper selection of suitable cases is needed to prevent iatrogenic fracture.

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Conflict of interest statement

All authors (T.H.L., K.K.C., H.C.C.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig 1
Uniportal endoscopic intramedullary debridement for management of tibial osteomyelitis of the right leg. The patient is in the supine position with the legs spread. Preoperative magnetic resonance imaging is used to locate the intramedullary abscess and the cloaca. (A) Coronal image. (B) Transverse image. (C, cloaca; IA, intramedullary abscess.)
Fig 2
Fig 2
Uniportal endoscopic intramedullary debridement for management of tibial osteomyelitis of the right leg. The patient is in the supine position with the legs spread. (A) The distance between the cloaca and medial malleolus is measured with MRI and the cloaca is located in the tibia. (B) A hemostat is inserted through the cloaca. (C, cloaca; MM, medial malleolus; MRI, magnetic resonance imaging.)
Fig 3
Fig 3
Uniportal endoscopic intramedullary debridement for management of tibial osteomyelitis of the right leg. The patient is in the supine position with the legs spread. The cloaca is drilled and enlarged to 7.5 to 8 mm in diameter. (A) Clinical photo. (B) Fluoroscopic view. (C, cloaca; D, drill; PS, previous saucerization.)
Fig 4
Fig 4
Uniportal endoscopic intramedullary debridement for management of tibial osteomyelitis of the right leg. The patient is in the supine position with the legs spread. The enlarged cloaca serves as both viewing and working portals (A) Clinical photo. (B) Fluoroscopic view. (C) The granulation tissue and loose bone fragments of the proximal half of the abscess are removed by an arthroscopic punch. (A, arthroscope; AP, arthroscopic punch; AS, arthroscopic shaver; GT, granulation tissue.)
Fig 5
Fig 5
Uniportal endoscopic intramedullary debridement for management of tibial osteomyelitis of the right leg. The patient is in the supine position with the legs spread. The enlarged cloaca serves as both viewing and working portals. The granulation tissue and loose bone fragments of the distal half of the abscess are removed by an arthroscopic punch. (AP, arthroscopic punch; GT, granulation tissue.)
Fig. 6
Fig. 6
Uniportal endoscopic intramedullary debridement for management of tibial osteomyelitis of the right leg. The patient is in the supine position with the legs spread. The enlarged cloaca serves as both viewing and working portals. After removal of all infected tissue of the abscess, the sclerotic abscess wall is removed with an arthroscopic acromionizer until capillary bleeding appears. (AA, arthroscopic acromionizer; SB, sclerotic bone.)
See this image and copyright information in PMC

References

    1. Arshad Z., Lau E.J.S., Aslam A., Thahir A., Krkovic M. Management of chronic osteomyelitis of the femur and tibia: A scoping review. EFORT Open Rev. 2021;6:704–715. - PMC - PubMed
    1. Bain K., Grohman R., Liu S., Rajaee S. Challenging case of an intramedullary tibial abscess in the setting of chronic osteomyelitis. BMJ Case Rep. 2018;2018 - PMC - PubMed
    1. Montgomery C.O., Porter A., 3rd, Sachleben B., Suva L.J., Rabenhorst B. Treatment of subperiosteal abscesses in children: Is drainage of the intramedullary canal required? J Pediatr Orthop B. 2017;26:497–500. - PubMed
    1. Oberst M., Niemeyer P., Suedkamp N. Endoscopic controlled intramedullary fracture reduction. A case report about closed fracture reduction under visual control. Arch Orthop Trauma Surg. 2007;127:647–649. - PubMed
    1. Saisu T., Kamegaya M., Watanabe A., Ochiai N., Takahashi K. Endoscopic surgery for chronic osteomyelitis extending across the physis. A report of two cases. J Bone Joint Surg Am. 2008;90:1744–1750. - PubMed