L-shaped corticotomy with bone flap sliding in the management of chronic tibial osteomyelitis: surgical technique and cl
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(2019) 14:47
RESEARCH ARTICLE
Open Access
L-shaped corticotomy with bone flap sliding in the management of chronic tibial osteomyelitis: surgical technique and clinical results Teng-fei Lou1†, Gen Wen1†, Chun-yang Wang1, Yi-min Chai1, Pei Han1* and Xiao-fan Yin2*
Abstract Background: We described the use of the technique of L-shaped corticotomy with bone flap sliding to treat chronic osteomyelitis of the tibia in eight patients and presented the preliminary results. Methods: L-shaped corticotomy with bone flap sliding was performed in eight patients between 2007 and 2014. All patients had chronic tibial osteomyelitis involving the anterior tibial cortex with intact and healthy posterior cortex. The size of bone defects following sequestrectomy and radical debridement was 8.1 cm on average. One patient required a latissimus dorsi flap. The mean follow-up period was 34.1 months. The functional and bone results were evaluated at the time of the latest follow-up. Results: Complete eradication of infection and union of docking sites were achieved in all patients. Functional results were judged excellent in five patients and good in the rest three patients. Bone results were graded as excellent in all cases. The mean external fixation time was 169.9 days and external fixation index was 21.2 days/cm. Pain was the most common complaint that we faced during lengthening. Pin tract infections were observed in four patients, and mild transient stiffness of ankle joint was observed in three patients. Conclusions: We have found this technique to be safe and effective, significantly diminishing the external fixation index. The earlier removal of the external fixator may result in increased patient comfort, a reduced complication rate, and a rapid and convenient rehabilitation. Keywords: Tibial osteomyelitis, L-shaped corticotomy, Bone flap, Bone transport
Introduction Chronic osteomyelitis of the tibia, which can be post-operative or secondary to open fracture [1], remains a considerable challenge to treat in clinical practice. Chronic osteomyelitis typically results in necrosis of soft tissues and bone to a variable extent. The necrotic bone forms infected foci for hosting pathogens. Furthermore, the host anti-infection mechanisms are frequently not in an ideal condition to resist microorganisms, and the
* Correspondence: [email protected]; [email protected] † Teng-fei Lou and Gen Wen contributed equally to this work. 1 Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China 2 Orthopaedic Department, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
poor circulation makes it hard to deliver an effective concentration of antibiotic to the infection site [2]. In order to create a vascular and viable environment, the first step of managing a chronic osteomyelitis is appropriate radical debridement requiring excision of all infected bone and soft tissue [3]. However, radical debridement and sequestrectomy often res
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