Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia

Abstract

Infected non-union of the tibia represents a major challenge to orthopaedic surgeons. Wide resection of infected tissues decreases the recurrence rate of infection in post-osteomyelitis reconstruction. Such radical debridement results in bone and soft tissue defects making the challenge more difficult with creation of a dead space. Elimination of the dead space is a necessity using antibiotic-impregnated cement as a staged technique for further reconstruction of bone and soft tissue. The objective of this series is to assess the efficacy of our integrated protocol for management of infected non-union of the tibia. This prospective study included 23 patients with infected non-union of the tibia with medullary contamination managed by staged debridement and insertion of antibiotic-impregnated cement spacer with later distraction histogenesis using Ilizarov frame for bone and soft tissue reconstruction. The mean age of the patients was 24 years (19 to 52). The mean size of the defect after debridement was 6 cm (range 4–10 cm). The average follow up period was 28 months (range 16–36 months). Successful reconstruction with no recurrence of infection was achieved in all cases (100%) without the need for bone or soft tissue grafts. External fixator index ranged from 35 to 60 days/cm (average 45 days/cm). The functional results were satisfactory in 20 cases (86.9%) and unsatisfactory in 3 cases (13.1%) due to residual leg length discrepancy, joint stiffness, and persistent pain. The proposed staged protocol represents a valid option for successful bone and soft tissue reconstruction and elimination of the infection without the need of bone grafting nor soft tissue procedures.