Single-stage treatment of chronic localized tibial osteomyelitis with local debridement and antibiotic-loaded calcium sulfate implantation:a retrospective study of 42 patients.

Abstract

Background: The management of chronic tibial osteomyelitis is still a challenge, even with various methods have been introduced. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis. Methods: 42 patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received above mentioned treatment method were included in the study. The infection remission rate, recurrence rate, complication rate and bone healing rate were respectively analyzed. Results: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients, pain, limitation of movement, sinus tracts, topical redness and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed slight but acceptable discomfort in affected limbs. 5 patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-rays examination, bone losses caused by local debridement were generally repaired, though the shape of tibia was not well restored to its initial form in 17 limbs. No fracture was recorded during follow-up. Conclusion: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.