Chronic osteomyelitis: a continuing orthopaedic challenge in developing countries

Abstract

Nine patients with chronic osteomyelitis, three with problems due to diagnosis, three with dilemmas regarding treatment and three with other complications are presented. It is suggested that although the diagnosis of osteomyelitis in most cases is straightforward, presentation might sometimes be similar to other conditions, which can lead to a dilemma in the diagnosis. Because of the formidable complications, which may be difficult to manage and the difficulty in guaranteeing permanent cure, the best approach is prevention by judicious treatment of acute haematogenous osteomyelitis and of open fractures.Résumé Présentation de 9 malades atteints d'ostéomy-élite chronique: trois avec des problèmes diagnostiques, trois avec des difficultés thérapeutiques et trois avec les plusieurs autres complications. Il apparait que bien que le diagnostic d'ostéomyélite soit dans la plupart des cas avancé facilement l'aspect peut parfois être trompeur, avec des hésitations diagnostiques. À cause des complications redoutables qui peuvent être difficiles à traiter et la difficulté d'obtenir une guérison, il faut insister sur la prévention par le traitement correct de l'ostéomyélite aigue hématogène et des fractures ouvertes. IntroductionThe diagnosis of chronic osteomyelitis spells a challenge, not only for the patient but also for the attending surgeon, due to the fact that treatment may not be effective because of the high recurrence rates and also due to potential complications. In the majority of patients diagnosis is usually straightforward; however, in some patients, different conditions may present with similar clinical features. This may pose a serious diagnostic problem because some of these conditions may be malignant.The improvement in both socio-economic status and health care delivery in developed countries has substantially decreased the prevalence of chronic osteomyelitis in their communities. However, unfortunately, in developing countries the situation is different. The incidence of acute haematogenous osteomyelitis is not only high but is either misdiagnosed or under-treated [5]. Apart from this, the increase in trauma, notably from road traffic accidents has resulted in an increase in open fractures and their complications [4]. These factors have meant that the prevalence of chronic osteomyelitis remains high; thus, posing a major orthopaedic challenge not only because of the high prevalence but also due to the difficulty in achieving a definitive cure and preventing serious complications.The aim of this study was to illustrate some of the challenges in the diagnosis and management of chronic osteomyelitis, particularly for the timing of surgery and possible options following bone loss due to destruction. Patients and methodsNine patients with chronic osteomyelitis are presented. Three of the patients had diagnostic problems; three with treatment dilemmas and three with complications. Diagnostic challengesThree young patients presented to us with a history of swelling of an extremity. There was no histo...

Diagnosis and treatment of pediatric chronic osteomyelitis in developing countries: prospective study of 96 patients treated in Kenya

“…The frequency of chronic osteomyelitis in Italy is about 2,000 new cases/year, while it is much higher in developing countries because of inadequate treatment of acute hematogenous osteomyelitis, exposed fractures, and wounds [12,13]. To our knowledge, there is no reported study on the frequency of acute and/or chronic osteomyelitis in Kenya.…”

“…To our knowledge, there is no reported study on the frequency of acute and/or chronic osteomyelitis in Kenya. In addition, the presence of bone sequestration in chronic osteomyelitis makes antibiotic treatment ineffective, since it hardly reaches the affected bone [2,12,13]. For these reasons, chronic osteomyelitis requires surgical-orthopedic and clinical interdisciplinary treatment, which is difficult to implement in countries lacking adequate resources and specialists.…”

“…In the literature, different operative techniques have been described, from simple surgical cleansing of necrotic areas to radical excision of focuses with microvascular flap reconstruction, to Papineau technique, to continuous bone washing after sequestrectomy, with or without antibiotic, to bone resection using Ilizarov devices, to Lautenbach method, and to Belfast technique in two sessions [14][15][16][17][18][19]. Scientific publications on chronic osteomyelitis in developing countries are very few and even fewer are literature studies conducted in children [2,12,13,16,17]. For this reason, we examined our series of cases with chronic osteomyelitis treated in Kenya, focusing on diagnosis, etiology, and treatment to evaluate the validity of treatment on the basis of outcome.…”

“…Literature studies do not report the prevalence rate of osteomyelitis in Kenya but only that it is higher in developing countries than in developed countries. The main risk factors of osteomyelitis are exposed fractures, surgical procedures, ongoing or previous infections in other sites, predisposing illnesses as sickle cell disease [8,[11][12][13].…”

Standard versus Specific Therapy for Chronic Osteomyelitis Treatment

“…This is due to some particular situations that characterize this type of infection; firstly, the drugs' difficulty of access into the site of the infection [3][4][5][6][7] ; then, the frequent presence of multi-drug resistant bacteria [8,9] and finally, problems in the identification of the real etiologic agent of the disease [10,11] . A large portion of osteomyelitis in adults is chronic.…”