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TREATMENT OF THE CRONIC WAR TIBIAL OSTEOMYELITIS, SUTILIO TYPE IIIB AND CIERNY MADER IIIB

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By Predrag Grubor et al. on February 5, 2014 Embj

Introduction: War osteomyelitis is an inflammation of all the bone elements at the place of bone fracture resulting from a war wound.

Method of work: During the Bosnian (1992-1995), 2,195 wounded people underwent primary surgical treatment for their wounded extremities. Tibia wounds were dominant in 695 (31.66%) of the cases, and 59 (8.48%) of which developed chronic osteomyelitis. The Gustilo’s Classification score was IIIB and the Cierny-Mader’s Classification score was IIIB. The average age of the patients was 38.2 years, sex representation: 57 (97%) males and 2 (3%) females. Cause of fracture: bullets 18 (31%), shell pieces 39 (66%), and combined 2 (3%), with polytrauma in 31 (52.54%). The most dominant infective agent was Staphylococcus aureus 31 (52%). We used Papineau’s method in 5 (8.50%), sequestration in 28 (47.45%), fenestration and sequestration in 17 (29%), only Forage of the tibia in 3 (5%), and decortication and resection in 6 (10%). We used the instantaneous vacuum for 36 (61%) patients. The aim of this work is to evaluate some perceptions in the therapy of the chronic fistulous war osteomyelitis tibia in a decade-long work. The study is retrospective and analyzes the use of surgical methods in the treatment of chronic osteomyelitis tibia caused by the high kinetic energy projectiles.

Results: Each of the 59 patients had an average of three surgical treatments. In spite of the above-mentioned treatments, 9 (15.25%) out of the 59 patients had chronic fistulous osteomyelitis. The average length of treatment was 36 days, and the duration of the exacerbation was 7 months. Transfusion was used for 23 (40%) patients. In the group of patients, the microbiological finding after operation was negative in 44 (75%). In 13 (22%) patients, infection manifested very early (i.e. during the first hospitalization).

Conclusion: Primary treatment of the war wound with sterilization is a crucial factor of acute (i.e. chronic osteomyelitis) prevention and sterilization is a general result of treatment. The optimal approach is to treat within 2 hours from the moment of injury. A multidisciplinary approach to treatment, highly sophisticated equipment in the diagnosis of injury, and the use of highly potent antibiotics of the newer generation, enable the achievement of full restitution of the wounded patient.

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Predrag Grubor et al.