The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] 18. J Bone Jt Infect. 2020 Dec 22;6(3):63-72. doi: 10.5194/jbji-6-63-2020. eCollection 2020. Simultaneous debridement, Ilizarov reconstruction and free muscle flaps in the management of complex tibial infection. Mifsud M(#)(1), Ferguson JY(#)(1), Stubbs DA(1), Ramsden AJ(1), McNally MA(1). Author information: (1)The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK. (#)Contributed equally Chronic bone infections often present with complex bone and soft tissue loss. Management is difficult and commonly delivered in multiple stages over many months. This study investigated the feasibility and clinical outcomes of reconstruction in one stage. Fifty-seven consecutive patients with chronic osteomyelitis ( n = 27 ) or infected non-union ( n = 30 ) were treated with simultaneous debridement, Ilizarov method and free muscle flap transfer. 41 patients (71.9 %) had systemic co-morbidities (Cierny-Mader group Bs hosts). Infection was confirmed with strict criteria. 48 patients (84.2 %) had segmental defects. The primary outcome was eradication of infection at final follow-up. Secondary outcomes included bone union, flap survival and complications or re-operation related to the reconstruction. Infection was eradicated in 55/57 cases (96.5 %) at a mean follow-up of 36 months (range 12-146). No flap failures occurred during distraction but 6 required early anastomotic revision and 3 were not salvageable (flap failure rate 5.3 %). Bony union was achieved in 52/57 (91.2 %) with the initial surgery alone. After treatment of the five un-united docking sites, all cases achieved bony union at final follow-up. Simultaneous reconstruction with Ilizarov method and free tissue transfer is safe but requires careful planning and logistic considerations. The outcomes from this study are equivalent or better than those reported after staged surgery. Copyright: © 2020 Max Mifsud et al. DOI: 10.5194/jbji-6-63-2020 PMCID: PMC7852407