Algorithm 8 - Management of Infected Tibial Non-union
How
to manage infected tibial Non unions ?
HiSTORY
History
of infection post operatively
Chronic
non healing draining sinus
Non
responsive to oral antibiotics
Investigations
Inflammatory
Markers persistently raised
X-ray
Non
– union
No cortical continuity
CT
– confirm non union
Look for sequestrum / dead bon e
MRI
– abcess
Culture
– Sinus fluid
Maagement
Cease
smoking
Maximize
nutrition
Optimize
medical conditions
Remove
metals
Take multiple cultures
Ream/Irrigate
Apply
Ilizarove
Manage
non union
Option 1 – Fibular Osteotomy
Acute compression over
next 10 days
Weight bear as tolerated
Watch non union
Option 2 – Exercise dead bone / non
uion , +/- fibular osteotomy
Acutely shorten and
compression distally
Proximal corticotomy and
bone transport.
Treat infection
Appropriate iv antibiotics for 6
weeks
Monitor inflammatory markers
2
)IM Antibiotics rod
Remove metal work
Make antibiotics rod
Chest tube with a
guidewire in it
Poor PMMA with
antibiotics (3 G Vancomycin, 3 G Flucolx )
Cut off plastic sleeve
Insert rod
Treat infection
6/52 of appropriate
antibiotics
Definite management of Non union
Return at 6/52 for
exchange nail / ilizarov
Bone grafting
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