[Minimally invasive hemi-cortical longitudinal bone transport technique for treatment of bone and soft tissue defects after tibial osteomyelitis surgery].

Objective: To investigate the effectiveness of minimally invasive hemi-cortical longitudinal bone transport technique for concurrent treatment of bone and soft tissue defects in patients with tibial osteomyelitis. Methods: A retrospective analysis was conducted on 14 patients with tibial osteomyelitis accompanied by bone and skin soft tissue defects, who were admitted between January 2022 and August 2023. There were 10 males and 4 females, with an average age of 51.2 years (range, 35-75 years). Traumatic osteomyelitis was diagnosed in 11 cases, and hematogenous osteomyelitis in 3 cases. The duration of infection ranged from 0.2 to 1.9 months (mean, 1.1 months). All bone defects were rated as Orthopaedic Trauma Association (OTA) type Ⅰ. The length of bone defects ranged from 3.4 to 6.2 cm (mean, 4.8 cm); the width of defects corresponded to 1/4-1/2 of the tibial circumference. The extent of soft tissue defects ranged from 6.5 cm×2.0 cm to 7.0 cm×3.0 cm. Upon admission, primary debridement and antibiotic calcium sulfate bead filling of the medullary cavity were performed, followed by antibiotic-coated bone cement coverage for soft tissue defects. After infection control, secondary minimally invasive tibial osteotomy was performed, followed by Orthofix unilateral external fixator for upper limb use to facilitate bone tissue transport. The time required for external fixation and bone transport was recorded, and wound healing status, bone healing progress, and adjacent joint function were observed. Scoring was performed according to the Paley healing criteria. Results: All patients completed two phases of treatment. The external fixation duration ranged from 2.1 to 6.5 months (mean, 4.5 months); bone transport duration ranged from 1.1 to 2.3 months (mean, 1.5 months); external fixation index ranged from 0.6 to 1.3 months/cm (mean, 0.98 months/cm). During bone transport, only 1 patient developed a pin tunnel reaction, with no other complications occurring. All patients were followed up 23-27 months (mean, 25.1 months). All wounds healed, with healing time ranging from 1.1 to 2.6 months (mean, 1.5 months); no infection recurrence was observed during follow-up. Imaging re-examination confirmed complete fracture healing, with healing time ranging from 2.6 to 3.5 months (mean, 3.2 months). At 3 months after discontinuation of bone transport, according to the Paley healing criteria, the bone healing in 14 patients achieved excellent; the joint function was rated as excellent in 11 patients and good in 3 patients. Conclusion: The minimally invasive hemi-cortical longitudinal bone transport technique demonstrates satisfactory effectiveness in the concurrent treatment of bone and soft tissue defects following tibial osteomyelitis.