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Chronic osteomyelitis. Use of ipsilateral fibular graft for diaphyseal defects of the tibia
1Department of Surgery, University of Calabar, Nigeria.
Insights
Acute osteomyelitis often leads to chronic bone issues. A non-vascularized fibular graft effectively bridged tibial defects, avoiding amputation in pediatric and adult patients.
Area of Science:
- Orthopaedic Surgery
- Pediatric Orthopaedics
- Trauma Surgery
Background:
- Acute hematogenous osteomyelitis affects 10% of pediatric patients in orthopaedic clinics.
- Late presentation is common, often resulting in chronic osteomyelitis with complications like discharging sinuses or ulcers.
- In adults, chronic osteomyelitis frequently arises from inadequately treated open fractures.
Observation:
- Severe osteomyelitis or injudicious sequestrectomy can cause significant bone length loss.
- Two cases are presented: an 8 cm tibial length deficit in a 5-year-old boy and an 8 cm deficit in a 30-year-old man.
- Both patients had experienced severe bone loss requiring intervention.
Findings:
- A non-vascularized ipsilateral fibular graft was used to bridge the tibial defects in both patients.
- Fixation was achieved using a tubular plate in one case and an intramedullary rush nail in the other.
- Both patients were able to bear weight at 4 and 6 months post-operatively, respectively.
Implications:
- This surgical technique demonstrates a viable method for limb salvage in cases of significant bone loss due to osteomyelitis.
- Non-vascularized fibular grafting offers a potential alternative to amputation for extensive tibial defects.
- Early intervention and appropriate surgical management are crucial for improving outcomes in osteomyelitis patients.
Abstract:
Acute haematogenous osteomyelitis is a major disease in this area, affecting 10% of the children seen in orthopaedic clinics. Few patients report early enough to benefit from antibiotic treatment, so the majority are seen quite late, usually in the chronic stage with discharging sinuses or chronic ulcers. In adults, chronic osteomyelitis results from inadequately treated open fractures. Injudicious sequestrectomy or very severe disease may lead to loss of length of the bone. A 5-year-old boy and a 30-year-old man suffered loss of length of tibia (averaging 8 cm). In an experimental work, a non-vascularised ipsilateral fibular graft was used to bridge the gaps in both tibiae, fixation was achieved with a tubular plate in one instance and an intramedullary rush nail in the other case. Both patients bore weight at 4 and 6 months, respectively. Amputation should therefore be avoided.