Tag Archives: debridement

Orthopedics, Pediatrics, Print Release

PUBLISHED: Debridement, Irrigation, and Decompression of the Bone for Chronic Osteomyelitis of the Distal Tibia and Active Sinuses

Debridement, Irrigation, and Decompression of the Bone for Chronic Osteomyelitis of the Distal Tibia and Active Sinuses
Samhita Kadiyala, BA1; Donald L. Fejfar, MD1; Nikhil Gattu, MD1; Emily S. Powis, BS1; Elizabeth Rich, MD2; Hizkyas Kassaye, MD3; Wesley Kalomba, MD4; Ridwan M. Saeed, MD5; Bitiel Banda, MD6; Pierre M. Woolley, MD7; Kiran J. Agarwal-Harding, MD, MPH1,8
1Harvard Global Orthopaedics Collaborative, Boston, MA
2Walter Reed National Military Medical Center, Bethesda, MD
3Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
4Lilongwe Institute of Orthopaedics and Neurosurgery, Lilongwe, Malawi
5Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
6Mzuzu Central Hospital, Mzuzu, Malawi
7Hôpital Universitaire La Paix, Port au Prince, Haiti
8Beth Israel Deaconess Medical Center, Boston, MA

Chronic osteomyelitis (COM) is a debilitating bone infection that presents a significant health burden in low- and middle-income countries. In children, it frequently results from delayed treatment of acute hematogenous infection. This case involves a 13-year-old male presenting with over one month of leg pain, difficulty walking, and three active draining sinus tracts along the medial distal tibia. Preoperative radiographs revealed a sequestrum involving nearly half of the distal tibia with an incomplete involucrum.

Surgical management focused on thorough debridement and decompression. The procedure involved making an incision to connect the sinus tracts, performing a sequestrectomy to clear the medullary canal, and using a drill to decompress a Brodie’s abscess. Debridement was continued until healthy bleeding bone was observed. Following saline and iodine irrigation, a gentamicin solution was applied as a local antibiotic adjunct. This case highlights the importance of balancing radical debridement with the preservation of structural stability in resource-limited settings. Postoperatively, the patient received broad-spectrum antibiotics and was maintained on partial weight-bearing to allow the involucrum to mature.

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Debridement and External Fixation for Bilateral Neglected Open Tibial Shaft Fractures

Debridement and External Fixation for Bilateral Neglected Open Tibial Shaft Fractures
Donald L. Fejfar, MD1; Nikhil Gattu, MD1; Ridwan M. Saeed, MD2; Hizkyas Kassaye, MD3; Bitiel Banda, MD4; Pierre M. Woolley, MD5; Kiran J. Agarwal-Harding, MD, MPH1,6
1Harvard Global Orthopaedics Collaborative, Boston, MA
2Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
3Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
4Mzuzu Central Hospital, Mzuzu, Malawi
5Hôpital Universitaire La Paix, Port au Prince, Haiti
6Beth Israel Deaconess Medical Center, Boston, MA

Open tibial shaft fractures represent a significant clinical challenge, particularly when presentation is delayed and wounds have become infected. This case demonstrates the surgical management of bilateral neglected open tibial shaft fractures in a young adult male who presented three weeks after initial injury from a motor vehicle collision in rural Malawi. He also suffered a bimalleolar fracture of the left ankle. The patient had grossly contaminated wounds with exposed bone and signs of infection bilaterally. The key procedural steps included aggressive irrigation and debridement of necrotic and infected tissue, skeletal stabilization with external fixation, local antibiotic therapy with gentamicin-impregnated collagen pellets, and soft tissue coverage with primary wound closure and a rotational subcutaneous flap on the left leg. External fixation is an essential treatment modality for open fractures with severe soft tissue injury when internal fracture fixation is not possible, especially in delayed cases with early signs of infection. This allows for staged management, repeated wound access, and preservation of blood supply while providing adequate stability for bone healing and soft tissue rest. This technique is particularly valuable in resource-limited settings where staged reconstruction and damage control orthopaedics are essential. The bilateral nature of these injuries, prolonged contamination period, immunocompromised status, and need for complex soft tissue reconstruction make this case unique and highlight the principles of managing neglected open fractures in challenging clinical circumstances.

Orthopedics, Print Release

PUBLISHED: Peroneal Tendon Debridement

Peroneal Tendon Debridement
William B. Hogan; Eric M. Bluman, MD, PhD
Brigham and Women’s Hospital

Tenosynovitis of the peroneal tendons is a common lower extremity problem that is often mistaken for other ankle pathology. Diagnosis is suggested with thorough history and physical examination and confirmed with radiographic studies when necessary. Patients with less acute or more severe presentation may improve with rest and physical therapy alone. When conservative management fails, surgical intervention is aimed at excising inflamed synovium with debridement and repair of any tears in the peroneal tendons. Recent literature has emphasized the increased use of tendoscopic approaches to peroneal pathology, although most studies to date have been too underpowered to suggest superiority to an open approach. This article presents a case of acute tenosynovitis treated by open surgical debridement and irrigation. Tendoscopy was deferred as the size and nature of this patient’s injury warranted an open repair.

Hand Surgery, Orthopedics, Print Release

PUBLISHED: Lateral Epicondylitis Debridement

Lateral Epicondylitis Debridement
Keenan R. Sobol, BS¹; Asif M. Ilyas, MD, MBA, FACS¹²
¹Sidney Kimmel Medical College at Thomas Jefferson University
²Rothman Institute at Thomas Jefferson University

Lateral epicondylitis (LE), commonly referred to as “tennis elbow,” is a common condition of the extensor tendons of the forearm that can lead to pain along the lateral epicondyle with radiation into the forearm, decreased grip strength, and difficulty lifting objects. When LE symptoms progress and can no longer be managed with non-operative measures, LE debridement may be indicated.

The approach presented here is an open debridement of the extensor carpi radialis brevis (ECRB) tendon origin. A 3–4-cm longitudinal incision was placed longitudinally over the lateral epicondyle, radial head, and capitellum. The ECRB was exposed then debrided, the lateral epicondyle was decorticated, the lateral collateral ligament was repaired, the wound was closed in layers, and a soft dressing and splint were placed.