INFECTIOUS OSTEITIS ON CONTINUOUS BONE TISSUE: 80 CASES INVOLVING THE LOWER LIMB

Abstract

Purpose of the study: When infection occurs on solid bone tissue, the problems which arise concern filling the bony defect, achieving effective antibiotic therapy at the bone level, and correct cutaneous coverage. We present our experience in the management of 80 cases of bone infection on continuous bone tissue of the lower limb.

Material and methods: This was a retrospective series of 80 cases of bone infection on continuous bone in the lower limb in 77 patients, mean age 45 years. The infection had on average persisted for 13 years and the patients had undergone on average six operations at the infected site. Bone infection was a posttraumatic complication in three-quarters of the cases and localized in the tibia in half. The general and local status was assessed for each patient using the Cierny-Mader classification. All patients underwent surgery using the same operative protocol: resection, filling, bone cutaneous cover. We describe the different operative phases and the techniques employed. Patients free of clinical or biological signs of recurrent infection two years after hospital management were considered cured.

Results: All patients were reviewed, there were no patients lost to follow-up. At mean follow-up of four years, 81% of patients were considered cured. Recurrent infection was observed in 14% of cases, requiring revision on average two years after initial management. For 5% of the cases, the initial treatment failed and was followed by amputation. Poor general or local status and extensive diffuse osteitis were factors predictive of poor cure of the infection.

Discussion: We discuss the different causes and pathogenic mechanisms of osteitis on continuous bone. Surgical techniques are compared. Bone infection on continuous bone is an ideal indication for muscle or fas-ciocutaneous flaps for filling bone cavities and achieving cutaneous cover. The different modalities and duration of antibiotic therapy are discussed.

Conclusion: Bone infection on continuous bone is a specific often poorly individualized clinical situation. A specific surgical protocol is indicated to fill bony defects, and achieve cutaneous cover and thus definitive cure.