In recent years, the number of victims of road traffic accidents (RTAs) and resulting surgeries have been on the rise in low income countries. Treatments are often long and costly; resources required to treat fracture related infections (FRI) continue to be a limiting factor in low income countries and standardized management protocols are lacking. This retrospective study reports our facility's experience of femoral FRI management in a low income country and evaluates the surgical outcomes with a minimum follow up of five years. The clinical and radiographic records of patients who underwent surgery for femoral FRI in our facility between 2005–2016 were analyzed. Twenty-six patients were included (15 males), with a median age of 29 years (range 4–71). The initial fracture was caused by RTA in 22 patients, gunshot in 2, accidental fall in 1 and acute osteomyelitis in 1. Polytrauma was observed in 10. All patients but one were referred for limb reconstruction from other institutions. Surgical treatment was instituted in all: site debridement (SD) alone was performed in 2 patients; SD and hardware removal in 4; SD and external fixation in 4; SD, hardware removal and external fixation in 16. In this latter group, complex treatments such as bone transport (BT) and vascularized fibula flap (VFF) were utilized in 4 and 3 patients respectively.Aim
Methods
Vascularized fibula flap is one of the available options in the management of bone loss that can follow cases of severe haematogenous osteomyelitis. The aim of this study was to evaluate the outcomes of this procedure in a pediatric population in a Sub-saharan setting. The retrospective study focuses on the procedures done in the period between October 2013 and December 2016. Twenty-eight patients, 18 males and 10 females, were enrolled. The youngest was 2 years old, the oldest 13. The bones involved were tibia (13), femur (7), radius (5) and humerus (3). In 5 cases the fibula was harvested with its proximal epiphysis, whereas in 17 cases the flap was osteocutaneous and osseous in 6 cases. In most cases, operations for eradication of the infection were carried out prior to the graft. The flap was stabilized mainly with external fixators, rarely with Kirschner's wires or mini plate. No graft augmentation was usedAim
Method
Segmental bone defects following osteomyelitis in pediatric age group may require specifically designed surgical options. Clinical and radiographic elements dictate the option. Different elements play a role on the surgeon's choice. Among them, the size of the defect, the size and the quality of the bone stock available, the status of the skin envelope, the involvement of the adjacent joint. When conditions occur, vascularized fibula flap may represent a solution in managing defects of the long bones even during the early years of life. A retrospective study, covering the period between October 2013 and September 2015, was done. Fourteen patients, nine males, five females, aged 2–13 years, with mean skeletal defect of 8.6 cm (range, 5 to 14 cm), were treated; the mean graft length was of 8.3 cm. The bones involved were femur (4), radius (4), tibia (3) and humerus (3). In 5 cases fibula with its epiphysis was used, in 5 cases the flap was osteocutaneous and in the remaining 4 cases only fibula shaft was utilized. After an average time of 8 months from eradication of infection, the procedure was carried out and the flap was stabilized with external fixators, Kirschner's wires or mini-plate. No graft augmentation was used.Aim
Method
Untreated or improperly managed osteomyelitis can lead to several complications, bone loss being one of the most challenging to manage. Bone transport is just one of the surgical options available for filling the bone gaps and promote bone union. This presentation focuses on bone transport for long bones gaps in paediatric age group, highlighting its advantages and disadvantages, its indications and its complications. Between 2006 and 2014. 71 patients underwent a procedure of bone transport. Out of them, 39 were males and 32 females, with an average age at presentation of 8.7 years. The bone involved were tibia (27 right, 25 left), femur (4 right, 9 left), radius (1 right, 4 left) and ulna (1 right). Clinically speaking, the children presented with one of the following picture: Pathological fracture, with sequestration without or minimum involucrum formation Extensive, extruded diaphyseal sequestrum, with loss of soft tissues Post-surgical gap, with residual or quiescent infection. Bone transport was preceded by one of the following procedure: sequestrectomy, sequestrectomy and external fixation, external fixation with sequestrum in situ. Monolateral fixator was used in 46 patients, ring fixator in 25. Bone transport started 7 days after the osteotomy, at the rhythm of 1 mm per day. Plastic surgery procedures were used in 3 kidsAim
Method
To present the results achieved with the use of external fixation techniques in treating 52 cases of post-traumatic and post-surgical septic non-union in a low resources setting. From 2006 to 2014 52 patients were treated for post-traumatic septic non-union of the lower and upper limb bones. Clinical records and radiographs were reviewed; telephone interviews were done for patients unable to reach our institution. There were 39 males and 13 females, with an average age at the time of admission of 29 years (the youngest patient was 8 years old, the oldest 81). Tibia was involved in 43 cases (24 right side, 19 left side), femur in 9 (4 right, 5 left) and left humerus in 1. All the patients, except two, had been treated in other institutions before admission. At presentation, 19 patients had an external fixator in situ, 18 patients had infected osteosynthesis, 15 had exposed necrotic bone, with loss of soft tissues. In 20 cases hardware removal, debridement and sequestrectomy were followed by application of an external fixator. In 31 cases bone transport was done; the fixator was monolateral in 27 cases. In 1 case sequestrectomy and external fixation were followed by a vascularized fibula graft. Bifocal bone transport was utilized in one patient while the bone transport procedure was associated to limb lengthening in 10 patients. Plastic surgery was required in 13 patients. Rotational flaps, vascularized free flaps and extensive skin grafts were all used. The site of non union was cured in all the patients, in an average time of 11 months (from 4 to 32). Two patients required an amputation a few months after the end of the treatment. There was need for fixator adjustment and screws replacement in 21 patients. Non-union at the docking point was observed in 5 patients; it was septic in two of them. There was need of skin-plasty in 2 cases for skin invagination. In 3 cases an extensive skin ulcer was observed during the transport procedure. Limb length discrepancy was corrected in 10 patients. A residual limb shortening was observed in 14 patients. Ankle fusion, knee fusion, foot drop, sensory loss in the foot, reduced range of joint motion were also observed. The external fixator plays a pivotal role in the treatment of septic non unions, especially in low resources setting. The treatment is long and costly. Strict medical supervision is necessary during the entire process.
The second group is classified as “Difficul osteomyelitis”. The bone involved presents with multiple erosions-cavities and there is no clear sequestrum on X-ray film. This category also includes those cases where surgery under tourniquet is impossible. Blood for transfusion must be available. Despite treatment, this type of osteomyelitis often recurs and further surgeries are often needed. All the cases of multiple osteomyelitis are included in this group as well. The third category covers “Complex Osteomyelitis”, whereby chronic osteomyelitis is associated with a pathological fracture or septic arthritis. There is axial deformity, bone loss and non-union. Some sort of reconstruction is always required.
