{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:44:43Z","timestamp":1766580283145,"version":"3.48.0"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Surgical treatment of chronic osteomyelitis of the proximal tibia is challenging due to limited soft tissue coverage, poor blood supply, and the weight-bearing function of the bone. Moreover, structural instability following curettage may necessitate fixation with metallic implants, which carries a risk of biofilm formation and often requires multi-stage surgeries. Methods: To address these challenges, we developed a new surgical technique combining an anterior approach with establishment of bone marrow communication via intramedullary reaming. The anterior approach provides central access to the infection site, minimizing cortical and cancellous bone loss and eliminating the need for internal fixation. Intramedullary reaming connects the infection site to the systemic circulation, enhancing local blood supply, facilitating intravenous antibiotic delivery, and promoting host immunity. Results: Fourteen patients with proximal tibia osteomyelitis were analyzed. The new surgical technique enabled precise targeting of the infection site, substantially reduced unnecessary bone loss, and eliminated the need for internal fixation. Excluding five cases with Cierny\u2013Mader (C-M) classification IV that required fixation due to inherent structural instability, all nine cases with C-M classification III were treated without internal fixation. Two out of three patients with severe post-traumatic osteomyelitis following Gustilo\u2013Anderson type III open fractures were successfully cured. At a mean follow-up of 53.7 months (range: 2.6\u2013104.9 months), 11 of 14 patients were completely cured with a single surgical intervention, corresponding to a 78.6% cure rate. Conclusions: This new surgical approach enables one-step surgery, avoids the risks of biofilm formation associated with additional fixation, and enhances treatment efficacy through enhancing host immunity, representing an effective strategy for managing proximal tibia osteomyelitis.<\/jats:p>","DOI":"10.3390\/jcm15010129","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:22:27Z","timestamp":1766578947000},"page":"129","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["New Alternative Surgical Technique for Managing Proximal Tibia Chronic Osteomyelitis: Anterior Approach with Establishment of Bone Marrow Communication via Intramedullary Reaming"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3726-4707","authenticated-orcid":false,"given":"Young-Chang","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-1944","authenticated-orcid":false,"given":"Seung Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.5435\/00124635-200510000-00006","article-title":"Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: Current management concepts","volume":"13","author":"Patzakis","year":"2005","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1086\/322972","article-title":"Biofilm formation: A clinically relevant microbiological process","volume":"33","author":"Donlan","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/01.TA.0000112327.50235.0A","article-title":"Long-term results of multiple-stage treatment for posttraumatic osteomyelitis of the tibia","volume":"56","author":"Tulner","year":"2004","journal-title":"J. Trauma"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/nyas.13016","article-title":"Niche heterogeneity in the bone marrow","volume":"1370","author":"Birbrair","year":"2016","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/BOT.0b013e318051532d","article-title":"Use of the reamer irrigator aspirator for the treatment of a 20-year recurrent osteomyelitis of a healed femur fracture","volume":"21","author":"Bellapianta","year":"2007","journal-title":"J. Orthop. Trauma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/BLO.0b013e318098673f","article-title":"Novel technique for medullary canal d\u00e9bridement in tibia and femur osteomyelitis","volume":"461","author":"Zalavras","year":"2007","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1016\/S0020-1383(10)70008-5","article-title":"Treatment of long bone intramedullary infection using the RIA for removal of infected tissue: Indications, method and clinical results","volume":"41","author":"Zalavras","year":"2010","journal-title":"Injury"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Besal, R., Adami\u010d, P., Beovi\u0107, B., and Papst, L. (2023). Systemic Antimicrobial Treatment of Chronic Osteomyelitis in Adults: A Narrative Review. Antibiotics, 12.","DOI":"10.3390\/antibiotics12060944"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/cis803","article-title":"Diagnosis and management of prosthetic joint infection: Clinical practice guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1053\/j.semnuclmed.2014.07.005","article-title":"Radionuclide imaging of osteomyelitis","volume":"45","author":"Palestro","year":"2015","journal-title":"Semin. Nucl. Med."},{"key":"ref_11","first-page":"20","article-title":"The role of nuclear medicine in the diagnosis of spondylodiscitis","volume":"16","author":"Treglia","year":"2012","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s13139-016-0441-x","article-title":"Comparative Analysis of (99m)Tc-MDP Three-Phase Bone Scan with SPECT\/CT and (99m)Tc-HMPAO-Labeled WBC SPECT\/CT in the Differential Diagnosis of Clinically Suspicious Post-traumatic Osteomyelitis","volume":"51","author":"Kim","year":"2017","journal-title":"Nucl. Med. Mol. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Shin, H.S., and Kim, M.B. (2025). Predictive Value of (99m)Tc DPD Bone SPECT\/CT Uptake Ratio for Culture Results in Lower Limb Osteomyelitis. Diagnostics, 15.","DOI":"10.3390\/diagnostics15162109"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1186\/s13018-019-1388-2","article-title":"A systematic review of the single-stage treatment of chronic osteomyelitis","volume":"14","author":"Pincher","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s13018-020-01721-7","article-title":"Single-stage treatment of chronic localized tibial osteomyelitis with local debridement and antibiotic-loaded calcium sulfate implantation: A retrospective study of 42 patients","volume":"15","author":"Zhou","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_16","first-page":"148","article-title":"Effectiveness of an Antibiotic-impregnated Bioabsorbable Carrier for the Treatment of Chronic Intramedullary and Diffuse Osteomyelitis","volume":"18","author":"Selvaratnam","year":"2023","journal-title":"Strategies Trauma Limb. Reconstr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wang, Y., Li, J., Zhang, X., Yang, X., Song, M., Lv, K., Xu, Y., and Shi, J. (2025). Clinical outcome of chronic haematogenous osteomyelitis of the femur or tibia in adults using selective segmental osteotomy and induced membrane technique. BMC Surg., 25.","DOI":"10.1186\/s12893-025-02865-1"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1302\/2058-5241.6.200136","article-title":"Management of chronic osteomyelitis of the femur and tibia: A scoping review","volume":"6","author":"Arshad","year":"2021","journal-title":"EFORT Open Rev."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Xue, B., Pan, Y., Wang, B., Dang, H., Li, T., Yang, C., and Fan, J. (2024). Simultaneous reconstruction of tibial osteomyelitis-complicated soft tissue defects using free flap transplantation in conjunction with the masquelet technique: A retrospective study. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-08026-4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101652","DOI":"10.1016\/j.jcot.2021.101652","article-title":"Treatment of postoperative tibial chronic osteomyelitis using bone transport techniques; an observational study","volume":"24","author":"Kliushin","year":"2022","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9070216","DOI":"10.1155\/2018\/9070216","article-title":"Management of Osteomyelitis-Induced Massive Tibial Bone Defect by Monolateral External Fixator Combined with Antibiotics-Impregnated Calcium Sulphate: A Retrospective Study","volume":"2018","author":"Qin","year":"2018","journal-title":"Biomed. Res. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1210\/er.2007-0038","article-title":"Osteoimmunology: Interactions of the bone and immune system","volume":"29","author":"Lorenzo","year":"2008","journal-title":"Endocr. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1038\/nri2062","article-title":"Osteoimmunology: Shared mechanisms and crosstalk between the immune and bone systems","volume":"7","author":"Takayanagi","year":"2007","journal-title":"Nat. Rev. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1038\/s41577-019-0178-8","article-title":"Osteoimmunology: Evolving concepts in bone-immune interactions in health and disease","volume":"19","author":"Tsukasaki","year":"2019","journal-title":"Nat. Rev. Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1146\/annurev.immunol.24.021605.090646","article-title":"Osteoimmunology: Interplay between the immune system and bone metabolism","volume":"24","author":"Walsh","year":"2006","journal-title":"Annu. Rev. Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1038\/s41392-023-01452-1","article-title":"Macrophages in immunoregulation and therapeutics","volume":"8","author":"Chen","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.abb.2008.03.018","article-title":"Functions of RANKL\/RANK\/OPG in bone modeling and remodeling","volume":"473","author":"Boyce","year":"2008","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"107102","DOI":"10.1016\/j.micpath.2024.107102","article-title":"A review of bacterial and osteoclast differentiation in bone infection","volume":"197","author":"Dong","year":"2024","journal-title":"Microb. Pathog."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4579","DOI":"10.12659\/MSM.903371","article-title":"Staphylococcus Aureus Induces Osteoclastogenesis via the NF-\u03baB Signaling Pathway","volume":"23","author":"Ren","year":"2017","journal-title":"Med. Sci. Monit"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e02447-19","DOI":"10.1128\/mBio.02447-19","article-title":"Staphylococcus aureus Infects Osteoclasts and Replicates Intracellularly","volume":"10","author":"Krauss","year":"2019","journal-title":"mBio"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/129\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:42:30Z","timestamp":1766580150000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,24]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010129"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010129","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,24]]}}}