CLINICAL ARTICLE

 

The treatment of tibial defects following chronic pyogenic haematogenous osteomyelitis in children

 

 

MN Rasool

FCS(Orth). Department of Orthopaedics, Nelson R Mandela School of Medicine, KwaZulu-Natal

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ABSTRACT

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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Reprint requests:
Mr MN Rasool
Department of Orthopaedics, Faculty of Medicine. Nelson R Mandela School of Medicine
Private Bag 7. Congella, 4013
Tel: (27) 031 260-4297; Fax: (27) 031 260-4518
E-mail: katia@ukzn.ac.za

 

 

No benefits of any form have been received from a commercial party related directly or indirectly to the subject of this article.