Osteomyelitis of the Long Bones

Abstract

Long bone osteomyelitis presents a variety of challenges to the physician. The severity of the disease is staged depending upon the infection's particular features, including its etiology, pathogenesis, extent of bone involvement, duration, and host factors particular to the individual patient (infant, child, adult, or immunocompromised). Long bone osteomyelitis may be either hematogenous or caused by a contiguous spread of infection. A single pathogenic organism is almost always recovered from the bone in hematogenous osteomyelitis; Staphylococcus aureus is the most common organism isolated. A variety of multidrugresistant organisms of bacteria continue to be a source of concern in arresting infection. The primary weapons to treat these infections are culture-specific antibiotics, aggressive debridement, muscle flaps, and bone grafts. This article offers a basic review of the classification, etiology, epidemiology, pathogenesis, and treatment of long bone osteomyelitis.

Antibiotic resistance pattern among aerobic bacterial isolates from osteomyelitis cases attending a Tertiary care hospital of North India with special reference to ESBL, AmpC, MBL and MRSA production

“…The Cierny-Mader classification is a clinical classification based on anatomic, clinical, and radiologic features. 4 Acute osteomyelitis is defined as an infection diagnosed within 2 weeks of the onset of symptoms. 5,6 Chronic osteomyelitis is a relapsing and persistent infection that evolves over months to years and is characterized by low-grade inflammation, presence of dead bone (sequestrum), new bone apposition, and fistulous tracts.…”

“…12,13 A single pathogenic organism is almost always recovered from the bone in hematogenous osteomyelitis, whereas, multiple organisms are usually isolated in contiguous focus osteomyelitis, especially in the diabetic foot. 4 15 Osteomyelitis is an ongoing problem due to emergence of multi drug resistant strains among bacterial pathogens causing it. Beta lactamases are the most evolving mechanism of antibiotic resistance among the family Enterobacteriaceae due to the selective pressure imposed by inappropriate use of third generation cephalosporins, most often encountered in ICU settings.…”

Effects of Local Antibiotic Delivery from Porous Space Maintainers on Infection Clearance and Induction of an Osteogenic Membrane in an Infected Bone Defect

“…While S. aureus is the most common cause of osteomyelitis, other bacteria such as coagulase-negative Staphylococci, Streptococcus spp., gram negative bacilli, anaerobic organisms, and polymicrobial infections can also lead to osteomyelitis. 16 We chose to use a single locally delivered antibiotic without systemic delivery in this study to minimize variables, but clinical situations may call for a combination of delivery methods and/or antibiotics. As such, further investigation of common antibiotics and combinations could yield useful information about the local response of induced membranes.…”

“…14,15 Staphylococcus aureus is the most common infecting agent in long bone osteomyelitis and is known to have deleterious effects on local cell populations. [16][17][18] In vitro studies have shown the effects of S. aureus on local cells to be far reaching, such as decreasing osteoblast viability and differentiation, inhibiting the multilineage potential of mesenchymal stem cells (MSCs), increasing the production of resorptive factors and increasing the production of proinflammatory cytokines. [17][18][19] These effects are not conducive to the regeneration of bone, and thus, local antibiotic delivery is intended to eradicate bacteria to restore the regenerative capacity of local cell types.…”

Vascularized fibular graft for chronic osteomyelitis of humerus in a 10 years child

“…The objective of dead-space management is the replacement of dead bone and scar tissue with durable vascularized tissue. Complete wound closure should be attained whenever possible, and local tissue flaps or free flaps may be used to fill dead space [1].…”