Management of Bacterial Chronic Osteomyelitis of the Shaft of Lower Limb Bones by Surgical Debridement with Bone Sliding in a Single Stage
Haitham Al-Ahmer
Fouad Al-Daoud
Gohar Mushtaq
Khaled Emara
During times of war injuries and irrational fracture management, cases of chronic bacterial osteomyelitis are highly likely to develop. This study aims to address chronic bacterial osteomyelitis efficiently with minimal time and fewer procedures. Our study focused on 31 patients over two and a half years. Clinical history, clinical examination, radiological investigations, and laboratory tests established the diagnosis with precision and certainty. Surgery was performed with meticulous, wide surgical debridement. External fixation was employed for bone and soft tissue reconstruction; in specific cases, internal fixation was used along with external fixation and treatment with antibiotics against the isolated pathogen. Of the thirty-one patients diagnosed with chronic bacterial osteomyelitis, nineteen (61.3%) had it in the femur, while the remaining twelve cases (38.7%) occurred in the tibia. Wide surgical debridement with tissue sampling was performed in all cases. External fixation alone was employed in 11 femur cases (57.9%) and 8 tibia cases (66.7%), whereas a combination of internal fixation and external fixation was utilized in 8 femur cases (42.1%) and 4 tibia cases (33.3%). In the femur patient group, bone results assessed using the ASAMI Scoring System were excellent in 10 patients (52.7%), good in 5 patients (26.3%), fair in one patient (5.2%), and poor in 3 patients (15.8%). Conversely, among the tibia patients, bone results were excellent in 10 patients (83.3%) and good in 2 patients (16.7%), with no cases falling into the fair or poor categories. External fixation plays a crucial role in bone and soft tissue reconstruction at the site of bone defects. In contrast, combined internal fixation may be warranted in cases with extensive bone loss following surgical debridement, thus aiming to reduce complications associated with external fixation alone.
Keywords:Chronic osteomyelitis, Surgical debridement, The shaft of the lower limb, Single stage, Bone sliding
