Comprehensive and individualized surgical treatment strategy for distal tibia osteomyelitis: a retrospective study of 70 patients

Abstract

Abstract Background Distal tibia osteomyelitis (DTO) treatment has become a challenging problem due to its difficult treatment and special location. Our goal is to provide a comprehensive and individualized treatment strategy, and to investigate the associated complications.Methods We retrospectively analyzed the data of 70 patients with DTO diagnosed and treated in our hospital from January 2015 to January 2022. The average age was 42.5 years (12–73 years), there were 34 cases accompanied by bone defects, and the average length of the bone defect was 3.2 cm (2 cm–17 cm). We divided the patients into three groups based on infection severity and specific location: 25 cases of a simple type (S type), 23 cases of complex ankle non-involved type (CAN type), and 22 cases of complex ankle involved type (CAI type). Comprehensive individualized treatment, including debridement, reconstruction, arthrodesis, and other surgical methods, was performed on patients of various types, rehabilitation exercises were guided, and patients were closely monitored. The efficacy was assessed using the following criteria: (1) treatment and related complications; (2) infection and defect healing; (3) improvement of ADL, VAS, and AOFAS scores; (4) evaluation of patients undergoing Ilizarov distraction osteogenesis; and (5) evaluation of patients undergoing ankle arthrodesis.Results The follow-up time was 30 months (10–84 months). With the exception of three patients who required amputation due to aggravated infection and concomitant basic diseases, all patients achieved infection control and healing, and the complications were properly treated. Three scores of patients with different types were significantly improved, and the differences were statistically significant. Patients undergoing Ilizarov distraction osteogenesis had satisfactory results, and the superior rates of ASAMI bone evaluation and function evaluation were 89%. All patients with ankle arthrodesis finally achieved bone healing, and the average fusion time was 4.5 months (3–7 months).Conclusion The comprehensive individualized treatment strategy is reliable for the treatment of DTO, as it can guide individualized treatment under different conditions, solve the problem of bone and soft tissue defects while controlling infection, reduce complications and properly handle them, and save as much function of the affected limb as possible.