Current Concepts Review   |    
Osteomyelitis in Long Bones
Luca Lazzarini, MD1; Jon T. Mader, MD2; Jason H. Calhoun, MD3
1 Infectious Disease Unit, Department of Internal Medicine, San Bortolo Hospital, Viale Rodolfi 47, 36100 Vicenza, Italy
2 Deceased
3 Department of Orthopaedic Surgery, University of Missouri, MC213, DC053.00, One Hospital Drive, Columbia, MO 65212. E-mail address: calhounj@health.missouri.edu
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Oct 01;86(10):2305-2318
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Osteomyelitis in long bones remains challenging and expensive to treat, despite advances in antibiotics and new operative techniques.

Plain radiographs still provide the best screening for acute and chronic osteomyelitis. Other imaging techniques may be used to determine diagnosis and aid in treatment decisions.

The decision to use oral or parenteral antibiotics should be based on results regarding microorganism sensitivity, patient compliance, infectious disease consultation, and the surgeon's experience. A suppressive antibiotic regimen should be directed by the results of cultures.

Standard operative treatment is not feasible for all patients because of the functional impairment caused by the disease, the reconstructive operations, and the metabolic consequences of an aggressive therapy regimen.

Operative treatment includes débridement, obliteration of dead space, restoration of blood supply, adequate soft-tissue coverage, stabilization, and reconstruction.

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    John W. Thompson, M.D.
    Posted on November 26, 2004
    Osteomyelitis, Current Concept Review
    Emeritus Fellow, AAOS

    To the Editor:

    I read with interest the Current Concepts review on osteomyelitis. I saw only a very few cases during the time I was in active practice until in 1998 when I made my first trip to a mission hospital in Kenya, Kijabe Medical Center. I returned to this facility annually, for approximately three weeks, through 2002.

    During the time that I was at Kijabe, I saw more chronic osteomyelitis than I ever thought that I would. Most of the cases were of the chronic type often with large involucrums that had to be removed surgically. It would have been very satisfying to have available all the antibiotics mentioned in your review, but all we had was cloxacillin and chloramphenocal, which have long ago disappeared from the armamentarium in the US. I only saw one case of MRSA in the five trips I made to Kenya.

    If an investigator really wants to gain a great deal of experience in treating chronic osteomyelitis, and too some degree acute osteomyelitis, he/she should go to a facility such as Kijabe Medical Center or some other good hospital in a developing country. If the investigator could take along all the antibiotics available in the first world, I am sure that he/she could accomplish a great deal of good as well as learning a lot about a scourge that runs rampant in the developing countries.

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