Management of childhood chronic tibial osteomyelitis with the Ilizarov method

The efficacy of the Ilizarov method in the management of the long bone defect is well established. There have been rare reports about the use of the Ilizarov method in the bone defect caused from childhood osteomyelitis. In this article, the authors present results of seven patients with childhood chronic hematogenous osteomyelitis of the tibia who were treated with the Ilizarov method. The treatment protocol also included sequestrectomy and debridement, appropriate antibiotic therapy, and bifocal treatment with the Ilizarov method. The mean age was 7.2 years old (range 6-8). After sequestrectomy and debridement, all cases were classified as B1 infected pseudoarthrosis according to Paley's criteria. All patients had active infection at the beginning of the treatment. The mean bone defect was 7.4 cm (range 3.5-12). Follow-up time was 4.6 years (range 2.7-5.8). At the time of fixator extraction, complete consolidation was obtained in all the patients. Healing index was 32.3 days/cm (range 28-44). Bone grafting was not required at the docking site in any of the patients. Functional and radiologic results were judged excellent according to Paley's criteria in all patients at the last follow-up. This study indicates that the bifocal method of the Ilizarov treatment is the best alternative for the bone defect caused by chronic hematogenous osteomyelitis in children.