Vascularized fibular grafting in the treatment of methicillin-resistant Staphylococcus aureus osteomyelitis and infected nonunion

Twenty patients with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and bone infection were treated with vascularized fibular grafts. There were 16 males and four females, and the patient ages at operation ranged from 17 to 73 years. Nine of the lesions affected the femur, eight the tibia, and there were three others. All of the patients were treated with extensive debridement of the lesions and local antibiotic therapy. Continuous local irrigation was applied in two patients, antibiotic-formulated bone cement in five, and both in 10 patients. Recurrence of local infection occurred in six patients, including one failed graft. Eventually, 18 of the 20 cases attained successful subsidence of the inflammation. The mean period required to obtain radiographic bone union was 7 months in the femoral reconstruction group, 6.1 months in the tibial reconstruction group, and 6 months in the remaining patients. The authors believe that vascularized fibular grafting is the most reliable procedure for the treatment of MRSA osteomyelitis and infected nonunion.