The treatment of chronic open osteomyelitis of the tibia in adults.
The treatment of 30 consecutive adult patients with chronic draining osteomyelitis of the tibia was reviewed. There were four treatment patterns. Eight patients had local debridement with or without soft tissue coverage procedures or bone graft. Three patients had radical debridement and bone transport using a circular frame. Eight patients were treated by the Papineau grafting technique after debridement. Eleven patients had debridement and circular frame fixation to correct associated nonunion, malunion, or shortening. All patients received long-term antibiotic therapy. At an average of 6 years' followup (minimum, 2 years), two patients had persistent drainage and one patient had an aseptic nonunion. This experience affirms the value of the circular frame, of the Papineau graft, of bone transport, and of long-term antibiotics for treatment of chronic osteomyelitis of the tibia. There was successful limb salvage in all of the patients and successful treatment (fracture healing without drainage) in 27 of 30 patients.


METHODS
Therapeutic study, Level III-1 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.
Beals
Rodney K
RK
Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code OP31, Portland, OR 97239, USA. bealsr@ohsu.edu
Bryant
Richard E
RE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
D000900:Anti-Bacterial Agents