Simultaneous debridement, Ilizarov reconstruction and free muscle flaps in the management of complex tibial infection.

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Abstract

Conflict of interest statement: Martin A. McNally and Jamie Y. Ferguson have provided consultancy for Bonesupport AB, which is not relevant to contents of this paper. Martin A. McNally is a member of the Editorial Board of this journal. The other authors declare that they have no conflict of interest. 19. BMC Musculoskelet Disord. 2022 Jan 6;23(1):38. doi: 10.1186/s12891-021-04979-y. Treatment of chronic osteomyelitis with antibiotic-impregnated polymethyl methacrylate (PMMA) - the Cierny approach: is the second stage necessary? Bor N(1)(2), Dujovny E(3), Rinat B(3), Rozen N(3)(4), Rubin G(3)(4). Author information: (1)Orthopedic Department, Emek Medical Center, Afula, Israel. noambor@yahoo.com. (2)Faculty of Medicine, Technion, Haifa, Israel. noambor@yahoo.com. (3)Orthopedic Department, Emek Medical Center, Afula, Israel. (4)Faculty of Medicine, Technion, Haifa, Israel. BACKGROUND: Chronic osteomyelitis is a challenge for orthopedic surgeons. Most patients with osteomyelitis receive two-stage management according to Cierny-Mader. The first stage includes radical debridement and insertion of an antibiotic-impregnated cement spacer (ACS) (beads, rods, nails, or blocks) into the bone defect. The second stage is performed 6-8 weeks later, when the spacer is removed and a cancellous autograft is placed within the bone defect. The possibility of ACS as definitive management for osteomyelitis, avoiding the second stage, is presented. METHODS: Sixteen patients with osteomyelitis received radical debridement and insertion of an ACS in all forms into the bone defect as a definitive management. In 8 patients, the tibia was infected, 4 had femur infection, 2 humerus, 1 fibula, and 1 ankle. The mean age at the time of the first stage of reconstruction was 49 years (range, 13-71 years). According to the Cierny-Mader classification, 1 patient was C-M IA, another was IB, 7 IIIA, 6 IIIB, and 1 was 4A. All B hosts had systemic illnesses. The mean follow-up period was 6 years (1.5-16 years). RESULTS: No patient exhibited radiographic evidence of excessive bone loss. Signs of recurrence of osteomyelitis were not noted in any of the patients, and no fractures had occurred by the last follow-up. CONCLUSION: Our study suggests that a proportion of patients with planned retention of ACS appear to function well without requiring further surgical intervention, especially in elderly or vulnerable patients. © 2022. The Author(s). DOI: 10.1186/s12891-021-04979-y PMCID: PMC8740499