BACKGROUND: The treatment of septic non-union of the tibia is a challenging area. The objective of this clinical study was to improve the treatment outcomes in patients with a highly active infection by the three strategies consisting of a two-staged operation, a flow-through technique for vascular anastomosis of a free vascularized fibular graft (FVFG), and continuous local intra-arterial infusion of heparin. PATIENTS & METHOD: Five patients with septic non-union of the tibia who were treated with an FVFG (mean age: 52.8 years) were enrolled. The mean postoperative follow-up period was 47.2 months, and the mean length of the bone defect was 111 mm. A two-staged operation, in which polymethylmethacrylate (PMMA) beads containing antibiotics were inserted into a bone defect followed by bone reconstruction performed with an FVFG later. Vascular anastomosis was performed with the flow-through technique in all patients. Immediately after FVFG, heparin was continuously infused through a femoral arterial catheter for 1 week. RESULT: Bone union was confirmed an average of 18.8 weeks after-surgery in all patients without reoperation for thrombus. CONCLUSION: Our attempt to apply the strategies appears to be a viable treatment option for septic non-union of the tibia.
BACKGROUND: The treatment of septic non-union of the tibia is a challenging area. The objective of this clinical study was to improve the treatment outcomes in patients with a highly active infection by the three strategies consisting of a two-staged operation, a flow-through technique for vascular anastomosis of a free vascularized fibular graft (FVFG), and continuous local intra-arterial infusion of heparin. PATIENTS & METHOD: Five patients with septic non-union of the tibia who were treated with an FVFG (mean age: 52.8 years) were enrolled. The mean postoperative follow-up period was 47.2 months, and the mean length of the bone defect was 111 mm. A two-staged operation, in which polymethylmethacrylate (PMMA) beads containing antibiotics were inserted into a bone defect followed by bone reconstruction performed with an FVFG later. Vascular anastomosis was performed with the flow-through technique in all patients. Immediately after FVFG, heparin was continuously infused through a femoral arterial catheter for 1 week. RESULT: Bone union was confirmed an average of 18.8 weeks after-surgery in all patients without reoperation for thrombus. CONCLUSION: Our attempt to apply the strategies appears to be a viable treatment option for septic non-union of the tibia.
Authors: Alfred T Culliford; Jason Spector; Alan Blank; Nolan S Karp; Armen Kasabian; Jamie P Levine Journal: Ann Plast Surg Date: 2007-07 Impact factor: 1.539
Authors: Akshar H Patel; J Heath Wilder; Olivia C Lee; Austin J Ross; Krishna C Vemulapalli; Paul B Gladden; Murphy P Martin; William F Sherman Journal: Orthop Rev (Pavia) Date: 2022-01-30