Treatment Of Post Traumatic Osteomyelitis And Infected Fractures Of

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Information about Treatment Of Post Traumatic Osteomyelitis And Infected Fractures Of

Published on April 29, 2008

Author: ashraf_970

Source: slideshare.net

Treatment of Infected Fractures and Post-traumatic Osteomyelitis of the Tibia with Local Fascio-cutaneous Flaps Ashraf Abou-Hussein Lecturer of Orthopaedics, Menoufiya University, Egypt

Post-traumatic osteomyelitis The primary objective of open fracture to render it a closed one When open fracture becomes infected, aggressive treatment should be instituted Long term morbidity

The primary objective of open fracture to render it a closed one

When open fracture becomes infected, aggressive treatment should be instituted

Long term morbidity

Fasciocutaneous flaps If available…. Depends on plexus of vessels running above the deep fascia Beware of traumatized skin

If available….

Depends on plexus of vessels running above the deep fascia

Beware of traumatized skin

Material 24 patients with infected open fractures and established post-traumatic osteomyelitis were treated in Menoufiya University Hospital over 5 years (from 2000-2005). Their age ranged from 9 to 63 years (average 29 years)

24 patients with infected open fractures and established post-traumatic osteomyelitis were treated in Menoufiya University Hospital over 5 years (from 2000-2005).

Their age ranged from 9 to 63 years (average 29 years)

Material Duration of infection (2 weeks- one year) 20 infected fractures 4 chronic osteomyelitis after fracture healing

Duration of infection (2 weeks- one year)

20 infected fractures

4 chronic osteomyelitis after fracture healing

Material Cirney-Mader Classification Type I 0…………….(Medullary) TypeII 10 cases… (Superficial) TypeIII 12 cases…….(cavity) Type IV 2 cases……(Segmental loss) 2 patients were diabetics, 60 and 63 years old 13 smokers

Cirney-Mader Classification

Type I 0…………….(Medullary)

TypeII 10 cases… (Superficial)

TypeIII 12 cases…….(cavity)

Type IV 2 cases……(Segmental loss)

2 patients were diabetics, 60 and 63 years old

13 smokers

Material Site of lesion Upper third 6 cases Middle third 11cases Lower third 5 cases Whole leg 2 cases

Site of lesion

Upper third 6 cases

Middle third 11cases

Lower third 5 cases

Whole leg 2 cases

Method All patients had multiple debridements except one case of upper third osteomylitis, had only one debridement

All patients had multiple debridements except one case of upper third osteomylitis, had only one debridement

Method Removal of any loose bony fragment Multiple debridements Judged by the clinical judgement of the wound No. of debridements (1-14 times!!!) (average three times)

Removal of any loose bony fragment

Multiple debridements

Judged by the clinical judgement of the wound

No. of debridements (1-14 times!!!) (average three times)

Method If a cavity is left in the bone (type III): Bone cement beads 11 cases Bone graft one case

If a cavity is left in the bone (type III):

Bone cement beads

11 cases

Bone graft

one case

Method Fasciocutaneous flap coverage Immediate flap elevation and inset…(17 cases).

Fasciocutaneous flap coverage

Immediate flap elevation and inset…(17 cases).

Method Flap Delay…………..7 apatients

Flap Delay…………..7 apatients

Method Flap Types Transposition fasciocutaneous flap (15 cases) Bipedicle fasciocutaneous flaps (5 cases) Cross leg fasciocutaneous flaps (2 cases) Reverse flow superficial sural artery flap (one case) Proximally based superficial sural artery flap (one case)

Transposition fasciocutaneous flap (15 cases)

Bipedicle fasciocutaneous flaps (5 cases)

Cross leg fasciocutaneous flaps (2 cases)

Reverse flow superficial sural artery flap (one case)

Proximally based superficial sural artery flap (one case)

Method Bone graft…..after 6 weeks By elevating the already healed flap

Bone graft…..after 6 weeks

By elevating the already healed flap

Results Follow up period (8 months- 5 years); average 2.2 years. For union Flap survival Presence of discharge

Follow up period (8 months- 5 years); average 2.2 years.

For union

Flap survival

Presence of discharge

Results Duration of hospital stay (10 days-4 months)

Duration of hospital stay (10 days-4 months)

Results No flap failure All fracture had united

No flap failure

All fracture had united

Results Failures: 2 cases had persitent discharge: 2/24 (0.83%)

Failures:

2 cases had persitent discharge:

2/24 (0.83%)

One case of persistent discharge ; it was upper third osteomyelitis treated by single debridemnet, and immediate bone graft (triple attack)!!

One case of persistent discharge ; it was upper third osteomyelitis treated by single debridemnet, and immediate bone graft (triple attack)!!

 

Another case with failure to achieve closure and persistent discharge (TypeIV) This patient was subsequently treated by Ilizarov segment transport by Dr. Mahmoud Al Rosasy Tanta University.

Another case with failure to achieve closure and persistent discharge (TypeIV)

This patient was subsequently treated by Ilizarov segment transport by

Dr. Mahmoud Al Rosasy Tanta University.

 

Dr. Al Rosasy, Tanta Univ.

Results One patient died after 8 months post trauma……after having union by Ilizarov segment transport…………..Acute renal failure

One patient died after 8 months post trauma……after having union by Ilizarov segment transport…………..Acute renal failure

THANK YOU

Case presentations

Discussion Debridement…..How much ?… Multiple debridements

Debridement…..How much ?…

Multiple debridements

Discussion Stable soft tissue skin cover is of primary priority for good long-term results . Local fascio-cutaneous flaps if available can provide this stable coverage and will enable the use of future bone graft through the same route.

Stable soft tissue skin cover is of primary priority for good long-term results .

Local fascio-cutaneous flaps if available can provide this stable coverage and will enable the use of future bone graft through the same route.

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