Treatment of chronic tibial osteomyelitis with external fixator

Summary

AIM:
The aim of the presented study was to assess the results of treatment of tibial osteomyelitis with external fixator, to compare the outcomes with other centres, and to propose a solution for improvement.

MATERIALS AND METHODS:
A total of 28 patients with tibial osteomyelitis were treated at the Traumatology Centre of the University Hospital Ostrava between 2000 and 2006. All patients underwent a complex treatment, where the decisive role is played by the remediation of the skeletal infection and treatment of the resulting bone defect. The skeletal stabilization was performed exclusively with external fixators. We evaluated the treatment results at two years after the completion of the treatment according to the ASAMI criteria. We assessed the results of bone healing, together with functional assessment, the number of necessary amputations and return of the patients to their original employment.

RESULTS:
We obtained results classified as “excellent” and “good” in more than 80 % of the patients. Consequently, we compared the observed results with other centres in the world dealing with this topic. It is possible to conclude, that our results were comparable. Nevertheless, the treatment period in these patients is very long and many patients suffer from permanent consequences of the injury, such as decreased mobility in the malleolar joint, limping and the necessity to use crutches.

CONCLUSION:
A complex treatment of osteomyelitis is a necessary precondition for successful treatment outcomes. Possible means of improving the results include an early debridement and the use of a suitable method of treatment of the bone defect, more active cooperation with specialists in the plastic surgery in performing a quality coverage of the sustained defects of soft tissues, necessary for healing of the skeleton, and a close cooperation with physiotherapists during an active and early rehabilitation treatment aimed at the quality of mobility of the malleolar joint and training of a correct gait stereotypes. This procedure will result in shortening of the treatment period and decreasing the extent of permanent consequences. An integral part of the treatment success is to teach the patient how to manipulate with the external fixator in such a way as to establish a “friendly relationship” between the patient and his external fixator.

Keywords:
chronic tibial osteomyelitis, external fixator, complex treatment.