broken tibia and fibula non union with infection

concern27,

Unfortunately, antibiotics alone will not take care of the infection. The mainstay of infection treatment in orthopedics is debridement (removing dead and infected tissue).

The presence of the metal in the area of the infection can act as a nidus. Many organisms that cause infection in bone and muscle form a biofilm, which adheres to the metal. So, it is usually recommended that all foreign bodies be removed.

During the removal of the hardware, the wound is thoroughly cleaned, taking out any nonviable tissue. It is not uncommon for the patient to have to have several surgeries to clean out dead, necrotic, infected tissue. The debridements are done until the wound is clean, with a good bed of granulation tissue.

During the series of debridement surgeries, sometimes the surgeon will place “antibiotic beads” in the wound. These are made of the material (cement) that is used to fix orthopedic devices in procedures like total joints. The cement is mixed with antibiotic powder and formed into beads or other shapes, and placed in the wound. The antibiotics beads help fight the infection locally. But, again, they can’t do it alone.

Then, once the infection is under control, the nonunion can be addressed. Sometimes, while the infection is being treated, the bone has to be stabilized with an external fixator. If the tibia is solidly fixed, and it is only the fibula that is being treated, it may be possible to get by with just a splint, and not have to have the external fixator.

Again, once the infection is gone, then the nonunion can be fixed and bone grafted. But, you do not want to put any foreign bodies (hardware/graft) back in, till the infection is gone.

During the debridements, the patient is usually given IV antibiotics. But, again, the antibiotics alone, will not eliminate the infection. Also, bone infection (osteomyelitis) is very difficult to treat. The amputation rate for osteomyelitis is still fairly high. So, it is not a problem to be taken lightly. And, with the current problem of bacteria being resistant to antibiotics, it is becoming even more difficult to treat.

One reason that the surgeon will usually not give antibiotics before the surgery, is that he/she will want to take cultures and biopsies of the infected tissue. This way, the exact bacteria that is causing the infection can be determined. Then, the proper antibiotics, specific to that particular bacteria can be given to the patient. If antibiotics are given before the surgery, it may alter the cultures.

So, your son has a long road ahead of him. Hopefully, the bacteria that is causing the infection is susceptible to antibiotics, and is readily eradicated. But, again, osteomyelitis is not to be taken lightly, it is a very serious condition.

While your son is fighting this infection, make sure that he eats a well balanced diet, with extra protein in it. He will need the extra protein to heal. He will also need extra calcium, vitamin D, and magnesium.

If at all possible, he should not smoke or use nicotine. Nicotine is probably the single most detrimental thing there is to bone healing.


Good luck. Wishing you and your son the best.

I can't thank you enough for your responce!! My son goes to hospital July 5th for surgery. They are removing hardware and said if needed they were going to do the antibiotics beads,bone graff,external fixture or cast.Not sure until they see what they are dealing with.Why would he have gotten an infection anyway? He doesn't smoke he has never been sick in the 27yrs of his life(just turned 27) at the time of his wreck he broke his shoulder it has healed great as well as his fibula so I'm confused as to why this is happening!! He is very depressed even tho he still works. You mention bone infection is this what the problem is?? Sorry so many questions.

concern27,

Unfortunately, any time you do surgery, there is a chance of infection. I assume this was a closed fracture. If it was an open fracture, or if there was any type of skin injury around the surgery site, the chances of infection are higher.

But, even with all of the precautions taken during surgery now days, there is still a very small number of infections which occur. Unfortunately, they happen. It is one of the known risks/complications of any surgery.

So, hopefully, it has been detected early, before the infection has "set up house". Deep infections and infections of the bone are very difficult to treat.

Usually, it is the infection that is the hardest part to treat. Once the infection is under control, it is usually fairly easy to treat the fracture.

But, as you state, the surgeon cannot really know what has to be done, till he/she gets in there; to see exactly what is going on. Once he/she knows what is going on, then the debridement of the infected/dead tissue is done. Sometimes, this is minimal. But, in others, it is extensive.

If the hardware is taken out and the bone needs support, when there is an infection, the orthopedic surgeon may apply an external fixator. These look like an erector set on the outside of the leg. They can really be a sight, if you do not expect to see it. But, if he does have to have an external fixator, don't worry too much. They are usually tolerated pretty well by the patient, and they allow the bone to be held in place while the soft tissues are taken care of.

It is great that he does not smoke. Do make sure that he is eating a proper diet. He will need the extra calories and nutrients to get rid of the infection and heal the tissues.


Again, unfortunately, sometimes infections just happen. It is sort of the luck of the draw. And, again, hopefully the surgeon is getting to it at an early stage, before it has gotten set up significantly. Keep your fingers crossed that it is a superficial infection, but be prepared for a deep infection, just in case.

Good luck. Hang in there. Wishing you the best.

Can you tell by an xray? He was taking antibiotics for about 10days before blood test blood test were all good does is that a good sign??? It also was leaking when he was up on feet for a long periode of time standing putting half of weight not walking at all. Liquid was clear orange color???

Sorry I have another question...I have google about this infection it states one of the symptons is swelling well it has always been swollen at times when leg is down it does have more swelling.Because he has not pain in the area is that postive. I guess you can see that I'm reaching for some good news!I have seen my son go through serious pain. He doesn't need pain medicines any more so to see this happen I'm hoping its not like day one of accident with added infection!! You have been so kind and I thank you so much! My son is so depress he doesn't ask any questions to doctor. He just stated he was afraid of losing his leg! So your answers are greatly appreciated.

concern27,

Your son has a lot a good things going for him. He is young and healthy, and does not smoke!! It is good that he does not have a lot of pain. He is not feeling ill. Often, patients with a smoldering infection just sort of feel lousy.

As to some of your questions:

It is possible to see osteomyelitis (bone infection) on x-ray, once it has reached the destructive stages. Which is pretty late in the course of an infection. Once it reaches this stage, the bone (on x-ray) can show sequestrum, involucrum, density, and/or light areas, which are big medical terms for holes and dead pieces of bone. But, again, this is very late in the course of osteomyelitis. Early infection may not have any signs on x-ray.

The blood work. In infections which are established and going strong, where the patient is ill, the CBC (complete blood count) usually shows signs of infection (elevated WBC - white blood cell count with a shift in the differential). But, again, in early infections, the patient's blood work may not show a lot.

This is why the cultures and biopsies taken at the time of surgery are very important. What the surgeon sees and feels during the procedure is also extremely important. Does the bone feel "normal" or is it soft? Are the soft tissues healthy appearing or are they friable, gray, noncontractile?


Hopefully, the infection is confined to the skin and subcutaneous tissues, and has not really started to work on the underlying bone yet. But, since there is no real separation of the tissues, if there is infection in the soft tissues, the area has to be thoroughly debrided, down to healthy bleeding tissue. Any foreign bodies (including orthopedic hardware) are usually removed, as they can be something for the infection to cling to. Foreign bodies also seem to act as a nidus for infection.

But, we can actually do a lot for osteomyelitis now days. Yes, it is a challenge to treat and eradicate, but it is usually successful. It is extremely rare now days for a part to have to be amputated due to an uncontrollable infection. It does occur, but again, it is very, very rare. And, usually, it is in patients who have many systemic illnesses and are not in the best of shape.

We have the capabilities to do the necessary debridements (that's a French word which basically just means that the wound/bone/whatever is thoroughly cleaned surgically), to hold the bone stable (external fixator, splints, casts, etc), and the antibiotics to kill the little buggers.


It is depressing to be injured and having to go through surgery. Then, add on top of that complications. So, it is not surprising that your son is down. But, as the saying goes, this too shall pass. Again, at least the problem can be treated and he is young and healthy. He has a lot going for him. Yes, it will test him and push him to his limits. But, he can do it, he has to do. You just tell yourself that that's what life has handed you, and you do the next step. Yea, it's the pits, but that's life.

This is where you come in. Give him as much support and encouragement as you can. Try to think of things that he can do to help divert his attention. Focus on things he can do, not what he cannot do.

But, do watch him. If the depression really sets in deeply, speak with his surgeon about it. Occasionally patients need to be treated for their depression. Sometimes medication is all that is needed, but other times counseling (psychotherapy) is also used. Depression is not a sign of weakness and the patient is not crazy. It is a medical illness, just like the infection. And needs to be treated if it becomes significant.


Again, hope your son does well with his upcoming surgery and that the infection is superficial. Keeping my fingers crossed. Good luck.