Purpose: To investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery.Methods: From July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications.Results: All patients were followed up for 24–60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87).Conclusion: Using a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase I treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.

Background: Osteomyelitis (OM) is a severe bone infection with rising incidence rates, particularly among elderly and diabetic patients. The immune–inflammatory axis is implicated in OM pathogenesis, but its complex interplay remains poorly defined. This study aims to explore the causal relationships between immunophenotypes, plasma inflammatory proteins, and OM using Mendelian randomization (MR) and bioinformatics. Methods: Utilizing publicly available genetic data, we undertook a series of quality control measures to identify instrumental variables (IVs) associated with exposure. Subsequently, we conducted MR using inverse variance weighting to explore the causal relationships between immunophenotypes, plasma inflammatory proteins, and OM. Bioinformatics tools were applied to explore the functional enrichment and protein–protein interaction networks of the implicated genes. Results: The MR analysis identified 13 immune cell phenotypes and 2 plasma inflammatory proteins associated with risk of OM. Notably, higher levels of HLA DR on plasmacytoid dendritic cells, memory B cell absolute counts, and CD8dim T cell percentages were associated with increased OM risk. Additionally, elevated levels of CD6 and IL‐12 subunit B were correlated with OM risk. Bioinformatics analysis revealed the enrichment of related genes in immune‐related pathways and highlighted the complex interaction networks of the implicated proteins. Conclusions: This study provides novel insights into the immune–inflammatory axis in OM and identifies potential biomarkers for risk assessment. The findings warrant further validation in diverse populations and pave the way for developing targeted preventive and therapeutic strategies for OM.

Objective. To study the role of bacterial biofilm (BBF) in the formation of chronic osteomyelitis and its prevention and treatment. Methods. In this paper, a large amount of relevant literature was searched for analysis and summary, and the key words chronic osteomyelitis, bacterial biofilm, infection, and debridement were searched in databases, mainly CNKI, Wanfang, and Wipu. The search was conducted until December 2020. The role of bacterial biofilm formation in chronic osteomyelitis and its prevention were analyzed. Results. Chronic osteomyelitis is formed mainly due to poor blood supply and drug-resistant bacteria, of which cellular biofilm is the most important cause. BBF forms on the surface of necrotic soft tissue and bone tissue, which has a protective effect on bacteria and greatly enhances their resistance to antibiotics, leading to difficulties in complete bacterial clearance and recurrent infections in osteomyelitis. Conclusion. Through an in-depth study of the molecular biology and signal transduction of osteomyelitis biofilm, antibiotic biofilm treatment strategies and surgical debridement remain the focus of clinical translation of chronic osteomyelitis.

If chronic osteomyelitis is not treated promptly and thoroughly, the wound will not heal for a long time, and the affected limb will be dysfunctional or disabled. In severe cases, it may even require amputation. In this article, a total of 50 patients with chronic osteomyelitis who meet the inclusion criteria were selected from January 2019 to March 2020 and were divided into two groups based on patient compliance, namely, a treatment group and a control group. The results of this group of studies showed that osteomyelitis is mostly manifested as limited diffusion, showing high signal on DWI, and ADC value is significantly higher than that of normal bone area. The normal bone area did not show obvious focal abnormal signals on the conventional MRI image. The ADC value of the measured patient’s osteomyelitis area was compared with the ADC value of the normal bone area. The ADC value was significantly higher than that of the normal bone area, and the difference was statistically significant. Studies have shown that membrane induction technology is superior to the bone handling group in terms of limb function scores and results satisfaction in the treatment of chronic osteomyelitis bone defects. Membrane induction technology has a low complication rate, a small number of X-ray examinations, a short healing time, and a high functional score. However, bone handling technology has a long treatment process, long fixation time and healing time, nail channel infection, joint stiffness, nerve damage, and many other complications.

Wuwei xiaoduyin (WWXDY) is a prescription for Chronic osteomyelitis (COM) in traditional Chinese medicine (TCM). However, its specific mechanism remains unclear. The objective of this study was to investigate the mechanism of WWXDY in COM treatment. To clarify the potential role of TAZ in the treatment of COM by WWXDY via regulatory CD4+ T cells differentiation. The expressions of TAZ, RORγt and Foxp3 were determined by Quantitative Real-time PCR and Western blot. Besides, levels of IL-21, IL-17 and IL-10 in peripheral blood were detected by using ELISA. Molecular dynamics simulations and docking were further utilized to explore the binding mechanism. COM resulted in abnormal cell differentiation and an imbalance of Treg/Th17. In comparison with the control group, the percentage of Treg cells, Foxp3 expression and secretion of IL-17 and −21 cytokines decreased (P < 0.001), while the proportion of Th17 cells, the levels of TAZ and RORγt and concentration of IL-10 in PBMCs increased in the COM group (P < 0.001). Furthermore, the above abnormal differentiation and function of Treg/Th17 cells in COM were suppressed after treatment with WWXDY in vivo and in vitro. In addition, TEAD1 inhibited the therapeutic effect of WWXDY in terms of Treg/Th17 cells with COM. it was found that the main active ingredients were cichoric acid and isocarlinoside. WWXDY regulates immunoregulatory properties of Treg/Th17 cells in COM mainly by mediating TAZ expression. By inhibiting the chronic inflammation in COM, WWXDY is potentially used to inhibit the progression of COM into bone tumors.

Chronic osteomyelitis of long diaphyseal bones often results in extensive structural bone defects following debridement. Traditional approaches such as cancellous bone grafting, fibular transplantation, the classical Masquelet technique, and the Ilizarov method each have inherent limitations when used alone, particularly for defects exceeding 10 cm. This study aimed to evaluate a modified Masquelet technique, in which the induced membrane cavity is reconstructed using vascularized fibular grafts, for the management of ultra-long segmental bone defects. Between January 2018 and November 2021, five patients (mean age, 50.2 years) with chronic osteomyelitis and diaphyseal bone defects (14–22 cm) were treated using a two-stage surgical protocol. Stage one involved radical debridement and antibiotic-loaded cement implantation. Stage two employed either free vascularized fibular grafts (n = 3) or ipsilateral pedicled fibular transposition (n = 2), combined with autologous iliac cancellous bone grafting. Fixation was achieved using plates (n = 4) or external fixation (n = 1). Patients underwent monthly radiographic follow-up for 9 months and functional evaluation at 12 months. This study was approved by the Ethics Committee of Tongde Hospital of Zhejiang Province (Approval No. ZTD Ethics 2024 Research No. 020-JY). All soft tissue defects were closed without tension, and flap donor sites achieved grade A healing. Patients were followed for an average of 23.4 months (range, 16–40 months). Bony union at both ends of the fibular flap was achieved in all cases, with a mean healing time of 3.8 ± 1.3 months. Complete cortical bone formation occurred in four patients within 7–8 months; one femoral case exhibited delayed integration at 18 months. No infections, graft failure, or donor-site complications were observed. Joint function in both adjacent and donor limbs was preserved or improved in all but one patient who had preexisting hip and knee stiffness. All patients regained independent ambulation. The modified Masquelet technique combined with vascularized fibular grafting is effective for reconstructing ultra-long bone defects following debridement for chronic osteomyelitis, providing robust osteogenesis and favorable functional outcomes. This combined approach reduces dependence on large-volume cancellous bone grafts and may be particularly suitable for complex cases requiring both infection control and structural reconstruction. Proficiency in microsurgical techniques is critical for successful outcomes.