TWO-STAGE REOSTEOSYNTHESIS OF TIBIA IN THE PATIENT WITH FRACTURE NON-UNION COMPLICATED BY POSTOPERATIVE OSTEOMYELITIS

Cover Page

Abstract

The authors present a case report of a patient with pseudarthrosis of the right tibia complicated by chronic postoperative osteomyelitis. The development of the osteomyelitis process is caused by locked intramedullary fixation of the right tibia by a retrograde nail. Unstable fixation led to the development of acute periimplant infection and osteomyelitis.

A radical surgical debridement of the focus site of chronic infection was performed by removing locking screws and nail, removal of necrotic bone tissues by handling the tibial medullary cavity by special reamers. The authors used the pulse lavage with active removal of the solution for an additional sterilization of the surgical wound and medullary cavity. A reinforced spacer impregnated with vancomycin and polyvalent bacteriophage was placed in the medullary cavity to ensure local prolonged antimicrobial therapy. Instead of the removed monomer the polyvalent bacteriophage was introduced into the polymer composition including phages against the main infectious agents in patients of traumatology and orthopedics clinic.

Three months after the first stage of treatment and stabilization of laboratory parameters the patient was readmitted to the clinic. The second stage of procedure included removal of spacer, closed antegrade locked internal fixation of the right tibia and talus by a nail with an antimicrobial coating of bone cement impregnated with vancomycin and a polyvalent bacteriophage. Antimicrobial coating of the nail was made intraoperatively using an original mold.

Two stage procedure allowed to achieve a stable remission of chronic osteomyelitis and stable internal fixation of tibia pseudarthrosis with preservation of the supporting function of the lower limb.

About the authors

I. M. Efremov

Ulyanovsk State University;
Chuchkalov Ulyanovsk Regional Clinical Center for Specialized Medical Care

Author for correspondence.
Email: efremov-im@rambler.ru

Cand. Sci. (Med.), Associate Professor and Senior Researcher of Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology, Orthopedics

Orthopedic Surgeon

42, ul. L’va Tolstogo, 432017, Ulyanovsk

28, ul. Koryukina, 432063, Ulyanovsk

Russian Federation

F. Ya. Sibaev

Chuchkalov Ulyanovsk Regional Clinical Center for Specialized Medical Care

Email: fake@neicon.ru

Orthopedic Surgeon

28, ul. Koryukina, 432063, Ulyanovsk

Russian Federation

G. A. Shevalaev

Ulyanovsk State University;
Chuchkalov Ulyanovsk Regional Clinical Center for Specialized Medical Care

Email: fake@neicon.ru

Cand. Sci. (Med.), Head of Course of Traumatology, Orthopedics, Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology, Orthopedics

Orthopedic Surgeon

42, ul. L’va Tolstogo, 432017, Ulyanovsk

28, ul. Koryukina, 432063, Ulyanovsk

Russian Federation

References

  1. Гурин Н.Н. Лечение ложных суставов, осложненных остеомиелитом. СПб.; 2004. 272 с. Gurin N.N. Lechenie lozhnykh sustavov, oslozhnennykh osteomielitom [Treatment of pseudarthrosis complicated by osteomyelitis]. St. Petersburg; 2004. 272 р. (in Russian).
  2. Девятова Т.А., Тимофеев В.Н. К вопросу применения чрескостного остеосинтеза при лечении боль- ных хроническим остеомиелитом длинных труб- чатых костей (обзор литературы). Гений ортопедии. 2001;(3):133-137. Devyatova T.A., Timofeev V.N. [Use of transosseous osteosynthesis in treatment of patients with chronic osteomyelitis of long tubular bones (Review of literature)]. Genij Ortopedii [Orthopаedic Genius]. 2001;(3):133-137. (in Russian).
  3. Зайцев А.Б., Митрофанов В.Н. Системный подход к реконструктивно-восстановительному лечению хронического остеомиелита голени. Медицинский альманах. 2010;11(2):215-218. Zaytcev A.B., Mitrofanov V.N. [Аpproach of the systems to reconstructive and regenerative treatment of chronic osteomyelitis of shin]. Meditsinsky al’manakh [Medical Almanac]. 2010;11(2):215-218. (in Russian).
  4. Мартель И.И. Чрескостный остеосинтез по Илизарову в комплексном лечении больных с открытыми повреждениями конечностей. Гений ортопедии. 2011;(2):50-54. Martel’ I.I. [Transosseous osteosynthesis according to Ilizarov in complex treatment of patients with open limb injuries]. Genij Ortopedii [Orthopaedic Genius]. 2011;(2): 50-54. (in Russian).
  5. Павлов Д.В., Новиков А.Е. Интрамедуллярный остео- синтез при лечении несросшихся переломов и ложных суставов большеберцовой кости. Травматология и ортопедия России. 2009;(2):106-111. Pavlov D.V., Novikov A.E. [Locked intramedullary osteosynthesis in nonunion and pseudarthrosis of the tibia]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of russia] 2009;(2):106-111. (in Russian).
  6. Fletcher Matt D.A. Одновременная билокальная компрессия зоны несращения бедренной кости и удлинение на интрамедуллярном гвозде. Новая методика и случай из практики. Гений ортопедии. 2015;(2): 69-71. doi: 10.18019/1028-4427-2015-2-69-71. Fletcher Matt D.A. [Simultaneous femoral bifocal non-union compression and lengthening over an intramedullary nail. A novel technique and case report]. Genij Ortopedii [Orthopaedic Genius]. 2015;(2):69-71. (in Russian). doi: 10.18019/1028-4427-2015-2-69-71.
  7. Иванов П.А., Соколов В.А., Бялик Е.И., Диденко О.А., Неведров А.В. Применение интрамедуллярных штифтов с активным антибактериальным покрытием при лечении тяжелых открытых переломов и их последствий. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2009;(1):33-18. Ivanov P.A., Sokolov V.A., Bjalik E.I., Didenko O.A., Nevedrov A.V. [Use of intramedullar locking nails with active antibacterial coating for the treatment of severe open fractures and their complications]. Vestnik travmatologii i ortopedii im. N.N. Priorova [Reporter of Traumatology and Orthopedics named Priorov]. 2009;(1):13-18. (in Russian).
  8. Соколов В.А., Иванов П.А., Бялик Е.И., Фаин A.M., Диденко О.А. Замена внешней фиксации на интрамедуллярный блокируемый штифт при открытых переломах длинных трубчатых костей у пострадавших с политравмой. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2007;(1):3-7. Sokolov V.A., Ivanov P.A., Bjalik E.I., Fain A.M., Didenko O.A. [Substitution of external fixation technique by intramedullary blocking nail in surgical patients with multiple injuries and open fractures of 3 long bones]. Vestnik travmatologii i ortopedii im. N.N. Priorova [Reporter of Traumatology and Orthopedics named Priorov]. 2007;(1):3-7. (in Russian).
  9. Thonse R., Conway J.D. Nonunions and segmental bone defects antibiotic cement-coated nails for the treatment of infected. J Bone Joint Surg Am. 2008;90(Suppl 4): 163-174. doi: 10.2106/JBJS.H.00753.
  10. Клюшин Н.М., Борзунов Д.Ю., Михайлов А.Г., Шляхов В.И., Шастов А.Л. Вариант тибиализации при ишемическом дистракционном регенерате больше-берцовой кости (случай из практики). Гений ортопедии. 2015;(2):65-68. doi: 10.18019/1028-4427-2015-2-65-68. Kljushin N.M., Borzunov D.Ju., Mihajlov A.G., Shljahov V.I., Shastov A.L. [Tibialization option for ischemic distraction tibial regenerated bone (a case report)]. Genij Ortopedii [Orthopаedic Genius]. 2015;(2):65-68. (in Russian). doi: 10.18019/1028-4427-2015-2-65-68.
  11. Преображенский П.М., Божкова С.А., Каземирский А.В., Гончаров М.Ю. Результаты этапного лечения пациентов с перипротезной инфекцией после эндопротезирования коленного сустава. Травматология и ортопедия России. 2017;(1):98-107. doi: 10.21823/2311-2905-2017-23-1-98-107. Preobrazhenskij P.M., Bozhkova S.A., Kazemirskij A.V., Goncharov M.Ju. [Results of Two-Stage Reimplantation in Patients with Periprosthetic Joint Infection after Total Knee Arthroplasty]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2017;(1): 98-107. (in Russian). doi: 10.21823/2311-2905-2017-23-1-98-107.
  12. Куропаткин Г.В., Ахтямов И.Ф. Костный цемент в травматологии и ортопедии. 2-е изд. доп., перераб. Казань; 2014. 188 с. Kuropatkin G.V., Ahtjamov I.F. Kostnyi tsement v travmatologii i ortopedii. [Bone cement in surgery]. 2nd ed. Kazan’; 2014. 188 р. (in Russian).

Statistics

Views

Abstract: 602

Cited-by

CrossRef: 2

  1. Prokhorova E, Urazgildeev R, Eremushkin M, Kolyshenkov V. Modern treatment approaches in patients with false joints and lower extremities long bones defects: analytical review. Bulletin of Restorative Medicine. 2020;96(2):84. doi: 10.38025/2078-1962-2020-96-2-84-89
  2. Clarke A, Soir SD, Jones J. The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review. Antibiotics. 2020;9(11):795. doi: 10.3390/antibiotics9110795

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies