Osteomyelitis of the tibia diaphyseal fragments persist, without fracture healing: antibiotic therapy and delay until tibial plateau fragments could be considered healed, then:
1. Removal of all plates of the tibia
2. Application of Ilisarov frame and local debridement
3. Further debridement with microbic research (still bacteriae found),
for definitive treatment we have to choose between
a) continue therapy with ilisarov frame and segmental bone transport or
b) bone resection and nail with antibiotics.
we discussed the 2 solutions ( a and b) with the patient:
- aggressive debridement, Ilisarov frame and segmental transport to fill the diaphyseal bone gap (we favoured this choice)
- aggressive debridement with bone resection, nail (with gentamicine antibiotics covered) from JJ, Synthes "Expert" and bone grafting
The patient decided for the second treatment choice, nevertheless he knew the major complication rate with this procedure, but he was tired about treatment with Ilisarov frame.
If you want to see the x-rays, click here