Tibial osteotomy and distraction osteogenesis for management of massive infectious compound defects of the tibia / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the therapeutic effects and complications of one-or two-site tibial osteotomy and distraction osteogenesis for treatment of massive infectious compound defects of the tibia.Methods A retrospective analysis was conducted of the 41 cases of massive infectious compound defects of the tibia which had been treated from May 2009 to May 2016 at The Traumatic Orthopedic Research Institute of PLA,Kunming General Hospital.They were 37 males and 4 females,aged from 2 to 58 years,with an average age of 33.4 years.The defects were located at the proximal tibia in 11 cases,at the middle tibia in 25 and at the lower tibia in 5.The defects of the anterior tibial soft tissue ranged from 7 cm × 8 cm to 24 cm × 12 cm in area;the tibial defects ranged from 6.5 cm to 18.2 cm (average,11.4 cm) in length.Metaphysis osteotomy of the tibia was performed at one site in 11 cases and at two sites in 30 cases.Bone and soft tissue healing and complications were observed.Results The postoperative follow-up periods ranged from one to 8 years,with an average of 32 months.Infections were all cured with no relapse of osteomyelitis,and all the bone defects and soft tissue wounds healed.Delayed healing at the docking site was observed in 4 patients but healing was eventually achieved after bone graft.Wound infection and poor osteogenesis appeared at the bone lengthening area in 3 patients which responded to placement of vancomycin bone cement rods for 2 months and "accordion" technique.Tibial line deviation was detected in 4 patients but disappeared after symptomatic treatment.Conclusions For a tibial defect from 6 to 8 cm combined with soft tissue defects,one-site tibial osteotomy and distraction osteogenesis can lead to fine healing;for a tibial defect from 8 to 20 cm combined with soft tissue defects,two-site tibial osteotomy and distraction osteogenesis can lead to fine therapeutic effects,due to reduced time for bone and soft tissue healing.