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

1) Ilizarov Technique
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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