Treatment of tibial osteomyelitis can be challenging and lengthy, with numerous complications possible during rehabilitation. We report on the usage of the Taylor Spatial Frame (TSF) for a large cohort of patients, and analyse factors that affect outcomes. Between 2015-2020, 51 patients were treated with TSF for osteomyelitis at a major trauma centre. Demographic, infection and treatment factors of: age, smoking status, diabetes, and BMI, acute (<6 weeks post injury) or chronic (>6 weeks) osteomyelitis, bacteria isolated, time to debridement, therapy/surgery number of TSF, time TSF was in, antibiotic treatment period, time to partial weight bear (PWB) and full weight bear (FWB) prescriptions, were collected. Outcomes of complications and time to union were obtained. Radiological union was achieved at mean 11.0 months. Mean follow up was 24.1 months. Six and three patients were further treated with fusion and amputation respectively. Mean treatment time with TSF was 12.1 months. 78% had some complications, with pin site infection, malunion, and non-union being most prevalent. Univariate factor analysis, multicollinearity diagnostics, then multivariate model construction were performed. Staphylococcus Epidermidis in bone debridement microbiology was significantly negatively associated with pin site infection (OR 0.093, 95% CI 0.011-0.828) and malunion (OR 0.698, 95% CI 0.573-0.849), and enterococcus with non-union (OR 0.775, 95% CI 0.656-0.916), during the treatment period. Time to union was significantly positively associated with time from admission to debridement (p=0.035), time TSF was in (p=0.021), presence of complications (p=0.045), bone loss complication(p=0.037), time to FWB prescription(p=0.001). We have analysed the effectiveness of TSF in the treatment of tibial osteomyelitis, and elucidated important injury, treatment and rehabilitation factors that affect outcome. The negative bacterial-complication cross associations could be due to successful eradication as culture specific antibiotics were used postoperatively. Earlier patient full weight bearing could enhance callous formation leading to faster union

The implementation of knee arthrodesis has become synonymous with limb salvage in the presence of chronic sepsis and bone loss around the knee. This can be seen in failed trauma surgery or knee arthroplasty as an alternative to trans-femoral amputation. There is no prior literature assessing which factors affect knee arthrodesis using external fixation devices. Sixteen consecutive patients (four women and twelve men) made up of eleven infected knee implants, three internal fixations of the tibial following fractured tibial plateau as well as 2 infected native joints were identified. The mean age at initial surgery was 56 years (range 25 to 82 years). All procedures were performed under the direct supervision of the limb reconstruction teams using a standard protocol with either a Taylor spatial frame or Ilizarov frame. The patient records, microbiology results and radiographs of all patients who underwent knee arthrodesis at this institution between 1999 and 2010 were reviewed. Of the 16 patients in this study knee fusion occurred in eleven patients (69%). The five patients where arthrodesis failed all had significant bone loss on the pre-operative radiographs and confirmed at surgery. We found a relationship between a significant infection of the knee with MRSA and failure to fuse. Three of the five patients had MRSA isolated from inside the knee at some stage during their treatment. The five patients where fusion failed were on average older (mean age 63 years against 51 years) and had more extensive bone loss. Those who failed to fuse had more co-morbidities. We would conclude that where there is little or no bone loss, arthrodesis of the knee can be reliably achieved with the use of circular frame fixation. A greater number of negative factors also prolongs the amount of time spent in the external fixator. The presence of significant bone loss, infection, increased age and multiple co-morbidities requires careful evaluation and consideration of trans-femoral amputation as an alternative