Aggressive management of tibial osteomyelitis shows good functional outcomes

Raewyn Campbell, M. G. Berry, Anand Deva, Timothy O’Carrigan, Ian A. Harris

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Severe open tibial fractures can be successfully treated acutely with a combined orthopedic and plastic surgery approach, but a proportion will go on to develop chronic osteomyelitis. For the past 6 years, an aggressive approach of bone and soft tissue debridement followed by skeletal reconstruction and vascularized tissue transfer has been pursued by the orthopedic and plastic surgery teams at Liverpool Hospital. We present the results of our patient series. Methods: All patients treated for chronic osteomyelitis by combined skeletal stabilization, debridement, and flap coverage between January 2000 and July 2006 were included. Clinical record review was combined with patient interviews and questionnaires. Outcome measures included fracture union, stable soft tissue coverage, freedom from infection, mobility, return to work/sport, and pain. Results: Twelve patients were followed up after a mean of 4.2 years. Patients had undergone a mean of 8.4 procedures prior to treatment, and a mean of 2.5 procedures as part of their treatment. We achieved fracture union, stable soft tissue coverage, and eradicated infection in all patients. All patients were walking, 10 unaided, and 80% had returned to work. All but one patient involved in sport at the time of injury had returned to sport. Two patients had mild pain when walking long distances only. Conclusion: Skeletal stabilization, debridement, and flap coverage is costly and complex surgery. However, in our series, these interventions resulted in eradication of infection and good clinical outcomes in most cases, providing an alternative to both amputation and longterm antibiotic therapy.
LanguageEnglish
Pages18-27
Number of pages10
JournalePlasty
Volume11
Issue numbere3
Publication statusPublished - 2011
Externally publishedYes

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Osteomyelitis
Debridement
Plastic Surgery
Walking
Sports
Orthopedics
Infection
Pain
Tibial Fractures
Open Fractures
Return to Work
Amputation
Therapeutics
Outcome Assessment (Health Care)
Interviews
Anti-Bacterial Agents
Bone and Bones
Wounds and Injuries

Cite this

Campbell, R., Berry, M. G., Deva, A., O’Carrigan, T., & Harris, I. A. (2011). Aggressive management of tibial osteomyelitis shows good functional outcomes. ePlasty, 11(e3), 18-27.
Campbell, Raewyn ; Berry, M. G. ; Deva, Anand ; O’Carrigan, Timothy ; Harris, Ian A. / Aggressive management of tibial osteomyelitis shows good functional outcomes. In: ePlasty. 2011 ; Vol. 11, No. e3. pp. 18-27.
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abstract = "Background: Severe open tibial fractures can be successfully treated acutely with a combined orthopedic and plastic surgery approach, but a proportion will go on to develop chronic osteomyelitis. For the past 6 years, an aggressive approach of bone and soft tissue debridement followed by skeletal reconstruction and vascularized tissue transfer has been pursued by the orthopedic and plastic surgery teams at Liverpool Hospital. We present the results of our patient series. Methods: All patients treated for chronic osteomyelitis by combined skeletal stabilization, debridement, and flap coverage between January 2000 and July 2006 were included. Clinical record review was combined with patient interviews and questionnaires. Outcome measures included fracture union, stable soft tissue coverage, freedom from infection, mobility, return to work/sport, and pain. Results: Twelve patients were followed up after a mean of 4.2 years. Patients had undergone a mean of 8.4 procedures prior to treatment, and a mean of 2.5 procedures as part of their treatment. We achieved fracture union, stable soft tissue coverage, and eradicated infection in all patients. All patients were walking, 10 unaided, and 80{\%} had returned to work. All but one patient involved in sport at the time of injury had returned to sport. Two patients had mild pain when walking long distances only. Conclusion: Skeletal stabilization, debridement, and flap coverage is costly and complex surgery. However, in our series, these interventions resulted in eradication of infection and good clinical outcomes in most cases, providing an alternative to both amputation and longterm antibiotic therapy.",
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Campbell, R, Berry, MG, Deva, A, O’Carrigan, T & Harris, IA 2011, 'Aggressive management of tibial osteomyelitis shows good functional outcomes' ePlasty, vol. 11, no. e3, pp. 18-27.

Aggressive management of tibial osteomyelitis shows good functional outcomes. / Campbell, Raewyn; Berry, M. G.; Deva, Anand; O’Carrigan, Timothy; Harris, Ian A.

In: ePlasty, Vol. 11, No. e3, 2011, p. 18-27.

Research output: Contribution to journalArticleResearchpeer-review

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Campbell R, Berry MG, Deva A, O’Carrigan T, Harris IA. Aggressive management of tibial osteomyelitis shows good functional outcomes. ePlasty. 2011;11(e3):18-27.