The patient, a 53-year-old male, had a history of diabetes mellitus for 1 year and no other underlying diseases.
On July 30, 2013, he was injured in a car accident and diagnosed with an open fracture of the left tibiofibula, and on the same day, he underwent “left tibiofibular fracture debridement + incision and internal fixation” in a local hospital. (This type of fracture of the fibula can be treated conservatively and left untreated.) After the postoperative review, no growth of the fracture end was seen 6 months later.
In January 2014, he came to our department and was diagnosed with infected osteochondrosis of the left tibiofibula. In April 2014, he underwent “left tibiofibular osteomyelitis lesion removal + external fixation frame”. The maximum distance of the bone defect was 4 cm during the operation.
On review in August 2014, the infection was stable and no recurrence was observed, and “left tibiofibular osteomyelitis debridement + internal fixation + iliac bone grafting” was performed, and postoperative recovery was possible. Subsequent follow-up showed gradual healing of the osteochondral nonunion. The treatment was successful.
In August 2015, the internal fixation was removed.
The following figure focuses on the fractured ends of the fracture.
Fracture fragment at the time of injury in July 2013
Internal fixation was performed on the same day
No growth of the fracture end after 3 months
No growth of the fracture end after 4 months
After 5 months, no growth was seen in our outpatient clinic
In April 2014, we performed internal fixation + debridement + external fixation
3 months postoperative infection control
In August 2014, we performed replacement of internal fixation + iliac bone grafting
4 months after surgery, we can see the growth of bone scab
6 months after surgery
8 months after surgery
10 months after the operation, the bone discontinuity was basically healed
At 12 months after surgery, the internal fixation was removed and the patient was basically cured and walking without any obstacle.
This is a typical case of osteomyelitis with typical onset + typical treatment + typical cure.
Many patients and family members who have questions about the treatment and prognosis of osteomyelitis can be fully understood by the above disease course + pictures. It may be difficult for ordinary people to read the X-rays, but the process of the above films can be summarized: the first surgery for complete debridement and the second surgery for bone grafting. If the treatment goes well, then usually two surgeries can achieve a cure. Of course, each patient’s situation is different and the treatment process will be different. But the total treatment process is shown above. I hope this article will be of intuitive help to patients and their families. (Please note that some of the films are upside down)