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SA Orthopaedic Journal

On-line version ISSN 2309-8309

Abstract

RASOOL, MN. The treatment of tibial defects following chronic pyogenic haematogenous osteomyelitis in children. SA orthop. j. [online]. 2008, vol.7, n.1, pp. 34-43. ISSN 2309-8309.

The aim of this paper was to review the results of treatment of 31 children, aged 3 to 12 years, with tibial defects resulting from haematogenous osteomyelitis seen between 1989 and 2006. Common features were skin defects, discharging sinuses, pathological fractures, sequestra and pseudarthroses, with a duration of 4 to 12 months prior to reconstruction. The defects ranged from 2 to 20 cm, 18 were in the proximal third of the tibia, 10 in the middle third, and three in the distal third. Surgical treatment consisted of repeated debridement, sequestrectomy, gentamycin beads and soft tissue cover for skin defects, followed by reconstruction at a later stage. Bone grafting was done by using cancellous chips in cavitating defects (Papineau technique) (n = 2), onlay grafting in defects < 2 cm (n = 5), corticocancellous square segments threaded and fixed over a Kirschner wire in the defect (n = 15), and fibular transference to the proximal tibia in large defects with poor skin and fibrosis (n = 9). All grafts healed well at 1 to 17 years follow-up. Complications of shortening (1 to 20 cm), equinus (1), ankle varus (3) and recurvatum (1) were related to the infective process. All patients are ambulant.

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