Abstract
Open tibia fractures have high complication rates. Progression to an infected nonunion is a dreaded complication, as these often require lengthy treatment with antibiotics and multiple surgical procedures and cause diminished patient quality of life. Accurate diagnosis and proper management of an infected nonunion is critical. When indicated, limb salvage should be attempted with careful, multistage surgical planning involving debridement and resection of infected soft tissue and bone, adequate soft tissue coverage, filling of osseous defects, and, finally, definitive bony fixation. Concurrent utilization of local and systemic antibiotics is also a crucial part of care. To illustrate these points, we present a case of an open tibia fracture complicated by an infected nonunion that required over 20 surgical procedures before aseptic bony union and recovery of a functional limb was achieved.
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Abbreviations
- I&D:
-
Irrigation and debridement
- PMMA:
-
Polymethylmethacrylate
- RIA:
-
Reamer-irrigator-aspirator
References
Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, et al. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg. 2016;151(11):1–12.
Thakore R, Francois E, Nwosu S, Attum B, Whiting P, Siuta M, et al. The Gustilo – Anderson classification system as predictor of nonunion and infection in open tibia fractures. Eur J Trauma Emerg Surg. 2017;43:651–6.
Singh A, Tan J, Hao J, Wei DT, Liang CW, Murphy D, et al. Gustilo IIIB open Tibial fractures: an analysis of infection and nonunion rates. Indian J Orthop. 2018;52(4):406–10.
Patzakis M, Zalavras C. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg. 2005;13(6):417–27.
Gitajn I, Titus A, Tosteson A, Sprague S, Jeray K, Petrisor B, et al. Deficits in preference-based health-related quality of life after complications associated with tibial fracture. Bone Joint J. 2018;100–B(9):1227–33.
Melvin SJ, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S. Open Tibial shaft fractures: I. evaluation and initial wound management. JAAOS. 2010;18(1):10–9.
Namdari S, Baldwin KD, Matuszewski P, Esterhai JL, Mehta S. Delay in surgical débridement of open tibia fractures: an analysis of national practice trends. J Orthop Trauma. 2011;25(3):140–4.
Siboni R, Joseph E, Blasco L, Barbe C, Bajolet O, Diallo S, et al. Management of septic non-union of the tibia by the induced membrane technique. What factors could improve results? Orthop Traumatol Surg Res. 2018;104:911–5.
Thonse R, Conway G, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects. J Orthop Trauma. 2007;21(4):258–68.
Mills L, Tsang J, Hopper G, Keenan G, Simpson AHRW. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res. 2016;5(10):512–9.
Amorosa L, Buirs L, Bexkens R, Wellman D, Kloen P, Lorich D, et al. A single-stage treatment protocol for presumptive aseptic diaphyseal nonunions: a review of outcomes. J Orthop Trauma. 2013;27(10):582–6.
Riel RU, Gladden PB. A simple method for fashioning an antibiotic cement–coated interlocking intramedullary nail. Am J Orthop. 2010;39(1):18–21.
Liu X, Ding G, Zhou D, Xiang L. Antibiotic-loaded bone cement spacer usage combined with membrane induction in infected gap non-unions: a case series. Pak J Med Sci. 2018;34(5):1088–93.
Mühlhäusser J, Winkler J, Babst R, Beeres FJP. Infected tibia defect fractures treated with the Masquelet technique. Medicine (Baltimore). 2017;96(20):1–7.
Gupta G, Ahmad S, Zahid M, Khan AH, Sherwani MKA, Khan AQ. Management of traumatic tibial diaphyseal bone defect by “induced- membrane technique”. Indian J Orthop. 2016;50(3):290–6.
Nieminen H, Kuokkanen H, Tukiainen E, Asko-Seljavaara S. Free flap reconstructions of Tibial fractures complicated after internal fixation. J Trauma. 1995;38(4):660–4.
Gonzalez MH, Weinzweig N. Muscle flaps in the treatment of osteomyelitis of the lower extremity. J Trauma. 2005;58:1019–23.
Dawson J, Kiner D, Gardner WI, Swafford R, Nowotarski PJ. The reamer – irrigator – aspirator as a device for harvesting bone graft compared with iliac crest bone graft: union rates and complications. J Orthop Trauma. 2014;28(10):584–90.
Conway J, Shabtai L, Specht S, Herzenberg J. Sequential harvesting of bone graft from the intramedullary canal of the femur. Orthopedics. 2014;37(9):e796–803.
Yin P, Ji Q, Li T, Li J, Li Z, Liu J, et al. A systematic review and meta-analysis of Ilizarov methods in the treatment of infected nonunion of tibia and femur. PLoS One. 2015;10(11):1–12.
Mcnally M, Ferguson J, Kugan R, Stubbs D. Ilizarov treatment protocols in the management of infected nonunion of the tibia. J Orthop Trauma. 2017;31(10):S47–54.
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Gadinsky, N.E., Levack, A.E., Wellman, D.S. (2020). Infected Nonunion of the Tibia. In: Reznicek, J., Perdue, Jr., P., Bearman, G. (eds) Musculoskeletal Infections. Springer, Cham. https://doi.org/10.1007/978-3-030-41150-3_6
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