Chronic osteomyelitis: what the surgeon needs to know

Abstract

Chronic osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation.It may present with periods of quiescence of variable duration, whereas its occurrence, type, severity and prognosis is multifactorial.The ‘gold standard’ for the diagnosis of chronic osteomyelitis is the presence of positive bone cultures and histopathologic examination of the bone.Its management remains challenging to the treating physician, with a multidisciplinary approach involving radiologists, microbiologists with expertise in infectious diseases, orthopaedic surgeons and plastic surgeons.Treatment should be tailored to each patient according the severity and duration of symptoms, as well as to the clinical and radiological response to treatment.A combined antimicrobial and surgical treatment should be considered in all cases, including appropriate dead space management and subsequent reconstruction. Relapse can occur, even following an apparently successful treatment, which has a major impact on the quality of life of patients and is a substantial financial burden to any healthcare system.Cite this article EFORT Open Rev 2016;1:128–135. DOI: 10.1302/2058-5241.1.000017.

Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis

“…The most common of these is trauma, with infection rates as high as 16% being reported in open long-bone fractures [2,3]. Other causes include joint arthroplasty and diabetic foot disease, both of which are becoming increasingly more prevalent as populations age [4][5][6]. Osteomyelitis can also result from the haematogenous spread of bacteria and this is especially important to consider in children.…”

“…The choice of drug is also guided by the clinical context. For example, in cases of osteomyelitis that are culture positive for methicillin-resistant Staphylococcus aureus (MRSA), a vancomycin-eluting scaffold should be used [6,47]. If the organism is unknown or the treatment is prophylactic, one may instead opt for a broader-spectrum drug such as tobramycin which is effective against both gram-positive and gram-negative bacteria [48].…”

Imaging Following Fractures of and Around the Knee

“…Radiographs are poorly sensitive and specific in the diagnosis; however, increased bone resorption, formation of sequestra, and new bone formation in the periosteum can be observed as late signs of chronic osteomyelitis. 26 Among cross-sectional and functional imaging tests, one meta-analysis showed that fluorodeoxyglucose positron emission Fig. 2 (a, b) Anteroposterior and (c) lateral views of the tibia plateau fracture before and after the operation with plating and screws showing one of the screws pointing to the joint space.…”

Acute hematogenous osteomyelitis in children: a case series

“…Moreover, complete cure is difficult to achieve. 1 The symptoms of acute osteomyelitis typically appear within two weeks after bacterial infection. Chronic osteomyelitis may progress six weeks after initial infection, and is marked by the presence of sequestrum.…”