Reason analysis and treatment of post-operative infection of tibial plateau fracture
10.3760/cma.j.issn.l001-2036.2011.03.006
- VernacularTitle:胫骨平台骨折术后感染原因分析及治疗对策
- Author:
Chun ZHANG
;
Lifeng SHEN
;
Zhan ZHANG
;
Qiaofeng GUO
;
Xiaowen ZHANG
;
Gouping MA
;
Fuhua ZHONG
- Publication Type:Journal Article
- Keywords:
Tibial plateau;
Fracture;
Musculocutaneous flap;
Transplantation;
Microsurgery
- From:
Chinese Journal of Microsurgery
2011;34(3):188-190,后插1
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the reason of post-operative infection of tibial plateau fracture, the therapeutic effect of using pedicle musculocutaneous flaps of proximal leg was researched and summarized. Methods There were 52 patients of tibial plateau fracture after internal fixation complicated by disunion of infected wound and soft tissue defects, traumatic osteomyelitis from January 2005 to May 2009. After pre-operative physical examination, laboratory examination, X-ray, CT scan and bacterial culture of the secretion,the operation, such as debridement, dead bone moving, medullary cavity cleaning, transferring to the external fixation when the internal fixation lost efficacy and bacterial culture of granulation tissue of different levels. The cavity was filled with RBK combined with vancomycin or tobramycin. If the cavity was rather large, autografts from the iliac bone were combined. The tissue defects were covered with pedicle musculocutaneous flaps of proximal leg, and the wound had effective drainage. The antibiotic was used for 3-4 weeks, and the X-rays were given at fixed period until the fracture was cured. Results The soft tissue defects of all 52 patients were repaired well. They were followed from 1 year to 5 years, and the time of bone union ranged from 4 months to 1 year. Two patients of osteomyelitis had a relapse after 3,4 months, then they were cured by the second operation. Three patients had unhealed fracture after 6 months, then they were cured by bone grafting again after 4-6 months. Conclusion Patients of tibial plateau fracture after internal fixation complicated by disunion of infected wound and soft tissue defects, traumatic osteomyelitis should be cured by comprehensive treatments, one of the crucial treatment for success is using pedicle musculocutaneous flaps of proximal leg to fill in lacuna, close wound, improve the local blood supply and promote bone union.
