Staged Treatment For Posttraumatic Osteomyelitis

Objective: Osteomyelitis is an inflammatory disease of bone which is difficult to cure. Posttraumatic osteomyelitis is a subtype of osteomyelitis, but be more difficult to treat due to always combining injury caused by trauma. The operation style for treatment of posttraumatic osteomyelitis is so much, that It’s very easy to make the surgeons shilly-shally and to select inappropriate decisions in operation style between arresting infection and reconstruction. For the situation of much operation styles at present, we retrospectively studied partial patients of posttraumatic osteomyelitis in our hospital from June 2013 to june 2015, to explore the nature and staged treatment for posttraumatic osteomyelitis, and to improve the effective treatment for posttraumatic osteomyelitis.Method: From june 2013 to june 2015, 39 patients(39 limbs) with posttraumatic osteomyelitis have been treated in our hospital. There were 29 males and 10 females with an average age of 43.8 years(range, 22 to 72 years). All of them were complicated with fracture, 1 cases of radius, metacarpal and phalanx in 9 cases, 16 cases of tibia and fibula, ankle and foot in 13 cases. Kirschner wire fixation of 9 cases, plate fixation of 10 cases, external fixator of 6 cases. 21 cases with skin defects, skin defect area of 1.5cm X 1.0cm ~ 30 cm X 15 cm. The average time from initial injury to preoperation was 4.28 months( range, 0.1 months to 24 months). Acute osteomyelitis in 7 cases, 8 cases of subacute osteomyelitis, 24 cases of chronic osteomyelitis. According to the definition of staged and one-stage treatment, there were 15 cases in staged treatment and 24 cases in one-stage treatment. In the staged treatment group, 3 cases of osteomyelitis wer dressing with VSD for drainage after debriding, the other were left open for drainage, 4 cases wound healed, 11 cases entered the late stage after arresting infection. In the late stage, 2 cases of dead space were filled with calcium sulfate impregnated antibiotics, 8 cases with free and pedicled flap for wound closure, 3 cases of skin grafts. In the one-stage treatment group, 3 cases of dead space were filled with calcium sulfate impregnated antibiotics, 1 cases was applied with osteocutaneous fibular graft, 1 cases were treated with iliac bone graft, 1 cases were packed with fascia. 19 cases with free and pedicled softtissue flap for wound closure, some cases combined with skin grafting, 5 cases with directly closing wound by suturing, 7 cases were performed washing drainage daily with physiological saline including gentamicin. When bone consolidation, nonunion or recurrence of osteomyelitis anyone was diagnosed, it is time for evaluation. The further improvement of the Aytac’s modified radiographic score was used for evaluating radiographic outcome. The scores of staged treatment group and one-stage treatment group were analyzed and compared by SPSS 22 software. P < 0.05 has statistical significance.Result: In an average follow-up 6.3 months( range, 2 to 19 months). 31 cases were followed. The one-stage treatment group had 18 cases, 13 cases of staged treatment group. Of which 23 cases achieved consolidation of bone, 7 cases of recurrence, 1 cases of nonunion. According to the standard of radiographic score for evaluation: 0 to 2 points in 17 cases, 3 to 4 points in 6 cases, 5 to 6 points in 4 cases, more than 6 points in 4 cases. The excellent rate of staged treatment group was 84.6%, the one-stage treatment group was 66.7%.Analysis and comparison was performed througe the software of SPSS 22.The comparison of score between staged treatment group and one-stage treatment group: The average score of staged treatment group: 2.0±1.7 points. The average score of one-stage treatment group : 3.7±2.5 points. p=0.041<0.05. Have statistical significance.Taking 6 weeks from the time of onset injure to debridement operation as the time division, compration between the staged and one-stage treatment group was performed : when the course less than 6 weeks: the average score of staged treatment group: 1.4 ± 0.8 points, the average score of one-stage treatment group: 3.8 ± 2.6 points P = 0.043 < 0.05, have statistical significance. When the course is greater than or equal to 6 weeks: the average score of staged treatment group: 2.7 ± 2.3 points, the average score of one-stage treatment group: 3.7± 2.6 points, P = 0.408 > 0.05, no statistical significanceTaking 6 weeks from the time of onset injure to debridement operation as the time division, compration was performed inside staged and one-stage treatment group: Staged treatment group: the average score when the course less than 6 weeks: 1.5 ± 0.8 points, the average score when the course is greater than or equal to 6 weeks: 2.4 ± 2.2 points, p = 0.337 > 0.05, no statistical significance. One-stage treatment group: the average score when the course less than 6 weeks: 3.8 ± 2.6 points, the average score when the course is greater than or equal to 6 weeks: 3.7 ± 2.6 points, p = 0.937 > 0.05, no statistical significance.Conclusion: According to the medical imaging of bone structure, the staged treatment must be adopted for treating post-traumatic osteomyelitis:debriding osteomyelitis, arresting infection, optimizing host factors early and reconstructing later stage. Aggressive treatment sooner the better.