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The dangers of tibial osteitis

Inherent dangers.

These include non-union, septicaemia, venous insufficiency and thrombosis as well as chronicity. The surgery associated with osteitis has its own dangers, which are increased by the multiple surgeries frequently needed, often in individuals with chronic illness and at times anaemic or otherwise deficient.

 

Iatrogenic dangers.

 Antibiotics sometimes used (notably Vibramycin) can produce liver and marrow damage, and should be given only in hospital.

Spread of infection to other patients by ward, theatre or staff transmission. Ideally an isolation unit should be used for the management of tibial osteomyelitis, but failing that admission and surgery during week- ends might reduce this risk.

Aggressive removal of tibial bone can leave the limb without skeleton support. Retained tibial bone, even if dead, contributes to stability and supplements in-growth of new bone. Therefore careful management planning is necessary to provide support by exo-fixators into living or dead bone. Vascularised composite bone grafting can be successful even in the presence of infection, to provide further support.

Removal of periosteum, one of the necessary components for re-growth of the tibial skeleton, is caused with aggressive removal of tibial bone.

Skeleton instability follows extensive excision of tibia. In some institutions this is managed by “calcaneal traction” via a pin driven into the heel bone.

Secondary infection of the calcaneum. In the presence of suppurating infection of the tibia, infection of the calcaneum following insertion of a traction pin is almost inevitable and catastrophic. This is because the calcaneum is “spongy” bone, and far more prone to infection than the dense tibia. Treating this iatrogenic calcaneal osteitis requires excision of bone, and frequently the entire calcaneum is lost. It is practically impossible to replace an excised calcaneum, and the loss of function is devastating.

Amputation of the leg is often the only practical solution once calcaneal osteitis has been allowed to compound an osteomyelitis in the tibia.

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