Clinical course, complication rate and outcome of segmental resection and distraction osteogenesis after chronic tibial osteitis

Abstract

Introduction: Radical segmental resection and subsequent distraction osteogenesis are considered the gold standard in the treatment of chronic tibial osteitis. We investigated the clinical course of treatment, particularly with respect to patients' quality of life, and the complication rate associated with this technique.

Methods: In this prospective case series, 25 patients (22 men, 3 women, average age: 46 years) with chronic post-traumatic tibial osteitis were managed operatively from 2006 to 2009. Standardised treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking manoeuvre. The follow-up rates during bacterial eradication, bone transport, post docking, and complete osseous consolidation were 100% while follow-up two years after completed consolidation was 76%. The main outcome measurements consisted of the quality of life (Medical Outcomes Study 36-Item Short Form Health Survey (SF-36 score)) and the virtual analogue scale (VAS) of pain during the five stages of therapy. Additionally, all complications and difficulties were documented.

Results: The average defect size was 5.3 cm (range: 3-13). The healing index was 57 days per cm transport (range: 18-172). The overall treatment time averaged 93 weeks (range: 38-183). Patients suffered 22 minor and 13 major complications including one amputation. The average complication rate per patient consisted of 0.88 minor and 0.52 major complications. After the period of bone transport, the physical and mental component summary scores increased continuously. After completed consolidation, the average mental summary score was comparable to a normal collective.

Conclusions: Distraction osteogenesis is challenging for both the patient and the surgeon. The arduous and demanding nature of the clinical course subjects the patient to considerable mental and physical stress. Thankfully, the average physical and mental status of health continues to improve during the clinical course of treatment. The 2-year success rate of the distraction osteogenesis in an infected tibia is 96%.