Initial Management:
(1) removal of all infected, non-viable bone and soft tissue
(2) bacteriologic control of the wound
(3) assessment of tibia and fibula
|
Type
|
Tibia
|
Ipsilateral Fibula
|
Functionality
|
Rehabilitation
|
|
I
|
intact
|
intact
|
able to withstand functional loads
|
6-12 weeks
|
|
II
|
intact
|
intact
|
bone graft needed for structural support
|
3-6 months
|
|
III
|
defect <= 6 cm after debrided
|
intact
|
|
6-12 months
|
|
IV
|
defect > 6 cm after debrided
|
intact
|
|
12-18 months
|
|
V
|
defect > 6 cm after debrided
|
not usably intact
|
|
>= 18 months
|
Type I:
(1) may follow soft tissue injury, with exposure of underlying bone
(2) Skeletal involvement is unicortical and debridement can be confined to the involved area with little or no threat to skeletal integrity.
Type II:
(1) The tibia is still in continuity but may fracture with functional loading unless bone graft performed.
Type III:
(1) 6 cm is used to separate different types based on successful bridging using autogenous cancellous bone alone; this can be expected to be successful within a reasonable time if the defect is less than 6 cm.
Type IV:
(1) Restoration of skeletal continuity is a challenge, requiring considerable time before independent weight-bearing can be achieved.
Type V:
(1) may follow a severe crushing injury
(2) reconstruction very complex with a long rehabilitation time
(3) amputation may be an alternative option, but reconstruction should be considered in the young or those with functional ankle and foot
