Dr H.P. Geisselhart is a General and Orthopedic Surgeon who has practiced in a large German hospital until 2011 and has won experience in rural Rwandan hospitals since 1984. Currently he is part of the Senior Staff in a clinic in Abuja, Nigeria.
Open tibia injury resulting in severe osteomyelitis can be prevented by earliest possible cleansing, debridement, coverage of the bone, immobilization of the leg and primary shortLterm cephalosporin therapy.
In case of a clear osteomyelitis, the bacterial load needs to be reduced from a high burden infection to a lowLgrade contamination. This can be achieved through a programmed surgical procedure in five steps without longLterm antibiotic treatment:
First the dead tissue needs to be removed. Second healing can be improved through continuous moist environment. Successively the bone should be covered with a regional flap or by granulationtissue in both cases combined with skin grafting.
The final two stages are focused on stimulating callus; through decortications and bone grafting via an unaffected approach (e.g. posterolateral to the dorsal tibia through the interosseous membrane) combined with increased weight bearing either in a Sarmiento cast or with an external fixator.
Different clinical examples from Rwanda and Nigeria are shown