Abstract
Introduction and Aims: Chronic pyogenic osteomyelitis, with pathological fractures, sequestra and subsequent bone defects, is still a major problem in developing countries. The treatment is challenging. Unhealthy skin with discharging sinuses make routine grafting procedures difficult. The aim of this paper is to describe the methods used to treat resulting defects.
Method: Thirty-four children, aged one to 12 years, treated between 1991 and 2002, were reviewed. The tibia was involved in 24 children, femur (five), radius (four), and ulna (one). Twenty-nine children had sequestrectomy and debridement. Five children presented with established bone defects. Bone defects measured 1–20cm. Four methods of grafting were used. Autogenous onlay grafts were used in defects < 2cm in seven children. The Papineau technique was used in cavitating defects in two, bicortical segmented iliac crest grafts (1cm x 1.5cm) threaded over a Kirschner wire were used in 15 defects (< 10cm) and bone transfer was performed in six children – proximal fibula to tibia (five) and radius to ulna (one).
Results: Three children required repeat grafting, one for fracture and three for non-union. All the remaining grafts incorporated by three to six months. Distal procedures including tibio fibular fusion and fibular epiphysiodesis were performed in six children. An above knee caliper was used in 11 cases till graft hypertrophy and consolidation occurred. All patients are ambulant presently. Shortening was treated with a shoe raise. Shortening ranged from 1–10cm. Fibula transfers showed hypertrophy with weight-bearing in all patients. Follow-up ranges from 10 months to 11 years.
Conclusion: Onlay grafting was successful in small defects < 2cm. Larger defects up to 10cm can be treated by segmented bicortical iliac crest grafts over a Kirschner wire, providing some stability and increased surface area for incorporation. Bone transfers should be reserved for difficult cases with extensive scarring and as an alternative to ablation in selected cases.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
