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