The treatment of chronic open osteomyelitis of the tibia in adults

The treatment of 30 consecutive adult patients with chronic draining osteomyelitis of the tibia was reviewed. There were four treatment patterns. Eight patients had local débridement with or without soft tissue coverage procedures or bone graft. Three patients had radical débridement and bone transport using a circular frame. Eight patients were treated by the Papineau grafting technique after débridement. Eleven patients had débridement and circular frame fixation to correct associated nonunion, malunion, or shortening. All patients received long-term antibiotic therapy. At an average of 6 years' followup (minimum, 2 years), two patients had persistent drainage and one patient had an aseptic nonunion. This experience affirms the value of the circular frame, of the Papineau graft, of bone transport, and of long-term antibiotics for treatment of chronic osteomyelitis of the tibia. There was successful limb salvage in all of the patients and successful treatment (fracture healing without drainage) in 27 of 30 patients. Level of Evidence: Therapeutic study, Level III-1 (case-control study).