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Chronic Posttraumatic Osteomyelitis and Infected Nonunion of the Tibia: Current Management Concepts

Dr. Patzakis is Professor and Chairman, The Vincent and Julia Meyer Chair, and Chief of Orthopaedic Surgery Service, USC University Hospital and LA County+USC Medical Center, Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA. Dr. Zalavras is Assistant Professor, Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Patzakis and Dr. Zalavras.

Reprint requests: Dr. Patzakis, University of Southern California Keck School of Medicine, GNH 3900, 2025 Zonal Avenue, Los Angeles, CA 90089-9312.

Chronic posttraumatic osteomyelitis and infected nonunion of the tibia are complex problems that result in considerable morbidity and can threaten viability of the limb. Development of infection may result from compromised soft tissue and bone vascularity, systemic compromise of the host, and virulent or resistant organisms. Biofilm formation on implant and devascularized bone surfaces protects pathogens and may lead to persistence of infection. Management is based on a detailed evaluation of the patient, the involved bone and soft tissues, degree of associated lower extremity inury, and type of bacterial pathogens. Infection control is achieved with radical débridement, skeletal stabilization, and microbial-specific antibiotics. Local antibiotic delivery is a useful supplement to systemic administration. Local or free muscle flaps may be necessary to achieve soft-tissue coverage. Restoration of bone defects and bony union can be accomplished with bone grafting. However, large defects require complex reconstructive procedures, such as distraction osteogenesis and vascularized bone grafting.

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