MICROSURGICAL TREATMENT OF SEPTIC NONUNION OF THE TIBIA - QUALITY-OF-LIFE RESULTS

The outcome of microsurgical reconstruction of septic nonunion of the tibia was described. The series consisted of 15 patients, with Cierny Stage IVA or IVB septic nonunion of the tibia, who were treated in the microsurgical practice of a major tertiary care hospital. Patients wi th a documented end point of either union or amputation were eligible for inclusion. Patients mere treated with wound excision followed by s oft tissue and skeletal reconstruction. The outcome measures of intere st included clinical measures (time to union or amputation, surgical c omplications, wound status) and health related quality of life measure s (Short Form-36, Western Ontario and McMaster Universities Osteoarthr itis Index, and patient satisfaction questionnaires). The average foll ow-up time was 3 years. There was 1 microvascular complication and no failures. Two of 15 patients (both Cierny IVB) required amputation aft er reconstruction. The time to union after bone grafting was an averag e of 6.5 months in May et al Type III legs (n=12), 3 months in May et al Type IV legs (n=1), and 16 months in May et al Type V legs (n=2). N ine patients completed the questionnaires; Short Form-36 scores were b elow normative values for the same age group, Scores on the activity l imitation component of the Western Ontario and McMaster Universities O steoarthritis Index seem to be comparable with those of individual's s cores after total knee replacement surgery Despite relatively low scor es on the questionnaires, most patients were either very or completely satisfied with the outcome of surgery Patients often reported that sa tisfaction was related to preservation of the limb.