Two-stage management of osteomyelitis complicating tibial shaft fracture

From June 1987 to May 1990, we treated 38 cases of osteomyelitis complicating tibial shaft fracture by a prospective two-stage treatment protocol. The patients' age ranged from 17 to 61 years (average, 35 years). The first-stage treatment, comprising radical debridement, antibiotic PMMA beads local therapy, external skeletal fixation and microvascular muscle flap, was to eliminate the infection. The second-stage treatment, comprising anterior autogenous cancellous bone-grafting, microvascular fibular bone transfer and Ilizarov intercalary bone transport, was to restore the tibial continuity. All patients were followed up for an average of 51 months (range, 36 to 72 months). Eradication of infection was achieved in 35 patients. The average duration of hospitalization of first-stage treatment was 20 days (16 to 31 days). Bone union was achieved in all patients. The time required for bone union was in proportion to the length of the skeletal defect remaining after debridement. There were 3 recurrences of infection which were successfully managed by repeating the two-stage technique. At the time of this review, there was no clinical infection of these 38 patients. We concluded that this two-stage management was effective. It ensured a rapid and predictable recovery from this disease.