Treatment Of Traumatic Osteomyelitis Of Tibia Associated With Bone Defect By Bone Removal With Ring External Fixator

BackgroundIn recent years,with the development of transportation industry,trauma and post-traumatic bone infection are not uncommon.Traumatic osteomyelitis is caused by infection after trauma or fracture,which is often characterized by chronic process,persistent infection,dead bone and sinus formation.The occurrence of traumatic osteomyelitis is related to the infection of dead bone and local wrapped soft tissue.Ischemia,infection of dead bone and wrapped soft tissue make it difficult to transport nutrition and antibiotics to the required site,resulting in the long-term failure of osteomyelitis.If debridement is performed,it is easy to cause long bone defects and is difficult to repair.Therefore,the treatment of traumatic osteomyelitis has always been a difficult problem for Department of orthopedics doctors.The tibia has a relatively weak anterior soft tissue because of its special anatomical characteristics.The blood circulation of the distal 1/3 of the tibia is poor and it is difficult to heal after the fracture.These characteristics make the tibia post traumatic infection more likely to occur,and the improper treatment can cause limb function.Disorder,disability,serious and even amputation.For the treatment of tibial traumatic osteomyelitis,the treatment of bone defect can be removed thoroughly,and the resulting bone defects can be treated in a variety of ways,including large amounts of cancellous bone graft,vascularized bone transfer,masquelet induced membrane technology and so on,and these methods are often treated with limited length of bone defect.Donor site will be further damaged,and vascularized bone grafting requires microsurgical techniques.With the appearance of ilizarov ring external fixator and the popularization of bone transfer technology,it is no longer a difficult problem for orthopedic doctors to reconstruct large bone defects and restore the function of affected limbs.Bone transfer is characterized by the gradual transfer of the bone segment near the defect area to the bone defect area through osteotomy,where the bone segment is joined with the contralateral end of the bone,and at the same time,With the action of distraction osteogenesis,the osteotomy will produce new bone and be reconstructed.This technique has unique advantages in the treatment of traumatic osteomyelitis of the tibia and the reconstruction of bone defects: it can completely remove infected areas;it does not need to find additional bone donor areas;it also resolves a variety of lesions,including segmental bone defects and limb shortening.Deformities,joint contracture and some soft tissue defects;early stabilization of bone,facilitate early movement of patients.However,the technique of bone transfer with ring external fixator seems simple,in fact,the operation is more frequent,the operation is complicated,the management after operation is complicated,the follow-up time is long,and various complications may occur in the course of treatment.In severe cases,amputation can be caused.Therefore,this study analyzed the effect of bone transfer with ring external fixator in the treatment of traumatic osteomyelitis of tibia associated with bone defect,and systematized the postoperative management,follow-up and functional exercise,and provided a prescription for the prevention and treatment of complications in order to further improve the curative effect.The purpose of preventing complications.ObjectiveTo summarize the effect of bone transfer with ring external fixator in the treatment of traumatic osteomyelitis associated with bone defect of tibia,systematize postoperative management,follow up and functional exercise,give the prescription for prevention and treatment of complications,analyze the complications and put forward preventive measures.MethodsFrom February 2014 to December 2016,26 cases of traumatic osteomyelitis associated with bone defect of tibia treated with ring external fixator bone transfer were retrospectively analyzed,including 18 males and 8 females,with an average age of 35 years,1456 years old,and 17 cases of traffic injuries,There were 6 cases of falling injury and 3 cases of heavy object injury.According to cierny-mader anatomical classification,6 cases were type III and 20 cases were type IV.The tibial osteomyelitis lesion was fixed with ring external fixator after debridement and bone movement was carried out.The length of bone defect,the time of bone transfer,the time of frame,the index of external fixator,the complications and the prevention and treatment were recorded.Results26 patients were followed up for an average of 19.7 months（12 28 months）.The average length of bone defect of tibia was 7.5 cm 4.5 ¹³cm ^-1,all of them were reconstructed,all the wounds were repaired,and no recurrence of infection was found.Complications included 3 cases of nail infection and 2 cases of soft tissue incarceration and poor union at the end of the union.One case of bone transfer malunion and one case of displacement force line long axis offset 1 case ankle joint function limitation.According to the results of paley and other infectious nonunion,23 cases were excellent and 3 cases were good.Functional score: excellent in 18 cases,good in 4 cases,moderate in 3 cases,poor in 1 case.ConclusionThe treatment of traumatic osteomyelitis of tibia with ring external fixator has the advantages of complete debridement,simple operation and less injury,and has a good effect on repairing bone and soft tissue defects and rebuilding the function of affected limbs.However,there may be complications in the process of moving,so we should do well in prevention and treatment.