MANAGEMENT OF SMALL INFECTED TIBIAL DEFECTS WITH ANTIBIOTIC-IMPREGNATED AUTOGENIC CANCELLOUS BONE-GRAFTING

Between January of 1991 and December of 1993, 36 patients who had tibi a fractures complicated by small infected tibia defects were treated a t the authors' service. The group included 30 men and 6 women whose av erage age was 36.5 years (range, 18-72 years). The average follow-up p eriod was 3.7 years. By using the Cierney-Mader staging classification of chronic osteomyelitis, 26 of 36 patients (72%) were stage 4A and 1 0 of 36 patients (28%) were stage 4B. Ten patients required muscle tra nsfer. All patients were treated with a two-stage protocol. In the fir st stage, antibiotic-impregnated polymethylmethacrylate bead chains we re used to obliterate the debrided osseous defect. In the second stage , the beads were removed, and the defects were reconstructed with anti biotic-impregnated autogenic cancellous bone graft. The time between t he first and second stage was 2 to 8 weeks for patients without muscle transfer and 8 to 12 weeks for the patients with muscle transfer. The bone defects ranged from 2 to 4 cm, Wound healing and bony union were achieved in all patients. Only two patients had recurrent infections. The infection arrest rate was 94.4%, Minor pin tract infection of the external skeletal fixation was seen in two patients. Two patients dev eloped skin rashes secondary to antibiotic therapy. Radiographs at an average follow-up of 3.7 years showed good consolidation and hypertrop hy of grafted bones in all patients. After 3 to 5 years of follow-up, our results suggest that the use of impregnating antibiotics have no a dverse effects on autogenic cancellous bone graft incorporation and ma y help to eliminate infection. This treatment protocol provided rapid recovery from osteomyelitis, The use of antibiotic-impregnated autogen ic bone graft seems to be an effective and safe method for the managem ent of small infected tibial defects.