External fixator combined antibiotic-calcium sulfate for the treatment of postoperative infected nonunion / 中国生化药物杂志

ABSTRACT

Objectives To explore the clinical effect of external fixator combined antibiotic-calcium sulfate packing medullary cavity, VSD continuous drain with negative pressure and local skin flap transposition for the treatment of postoperative infected nonunion after initial debridement. Methods 20 cases of traumatic osteomyelitis from August 2012 to August 2014 were selected and taken antibiotic-calcium sulfate to focal zone. The patients were taken first-stage bone grafting for small bone defects and osteotomy for lengthening for big bone defects. For patients with cutaneous injury, local skin flap transposition was taken. For other patients with partial flap necrosis and non healing wounds, VSD continuous drain with negative pressure was taken. Results Operative incisions of 12 cases were primary healing, two cases were healing by second intention, four cases of flap were survived after local skin flap transposition, and two cases of flap were partial necrosis and healed by second intention. 11 cases of immobilization with external fixator, bone healing was satisfactory in seven cases after osteotomy for lengthening and two cases of bone delayed union in osteotomy for lengthening and recovered after bone transplantation. All patients were followed up for average 19(6-32) months with permatoplasty survived; all the infection of wounds was controlled and relapse-free. The fracture healing period was eight(4-12) month without pin site infection, osteoporosis and deformed healing. But there were 1 cases of knee stiffness and two cases stiffness of ankle joint. Conclusion After initial debridement, taken external fixator and taken antibiotic-calcium sulfate to medullary cavity and fracture ends. The patients were taken first-stage bone grafting for small bone defects and osteotomy for lengthening for big bone defects. For the skin defect after local flap grafting, taken VSD continuous drain with negative pressure for partial necrosis of flap occurred and non healing wounds cases. The method obtained prominent curative effect, reduces the treatment cycle and reduce the complications in the treatment of postoperative infected nonunion.