MANAGEMENT OF CHRONIC OSTEOMYELITIS SECONDARY TO COMPOUND FRACTURES

Abstract

The authors feel that the management. of osteomyelitis secondary to infected compound fractures should consist in débridement and saucerization, with closure of the wound by primary suture, if it can be done without excessive tension. Otherwise, the method of delayed closure by split-thickness skin grafts should be used. After healing of the infection, union will occur in many cases of previous non-union. Many patients need no further surgery after wound healing because of adequate remaining bone, and because the bone and skin pockets are small. With non-union, large bone defects, or large bone and skin pockets, and in those cases in which reinforcement is required for stability, three months should elapse after complete healing of the wound before bone-grafting is done. The use of cancellous bone, from which as much cortex as possible has been removed, is recommended. If the defect is large, it may be difficult to obtain sufficient bone without the use of cortical chips. The authors have had no experience with bone grafts at the time of débridement and saucerization, but this seems to be the next step in evaluating the management of chronic osteomyelitis. Careful preoperative and postoperative preparation with antibiotics and blood transfusions is essential. As postoperative drainage appeared to result from hematoma, which was prone to become infected, it is suggested that delayed primary closure of the wounds would give a higher percentage of complete early healing. The authors see no reason why chronic osteomyelitis of hematogenous origin could not be managed in a similar way.