0
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
View Disclosures and Other Information
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
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

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.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    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.

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Guidelines
    Feverish illness in children: assessment and initial management in children younger than 5 years. -National Collaborating Centre for Women's and Children's Health | 8/28/2009
    Results provided by:
    PubMed
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    02/19/2014
    OH - University Hospitals Case Medical Center
    03/27/2014
    MA - Boston Medical Center and Boston University School of Medicine
    02/05/2014
    OR - The Center - Orthopedic and Neurosurgical Care and Research