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Osteomyelitis (Bone Infection)

Chronic osteomyelitis is one of the few infectious diseases that probably became more common in the 20th Century than it had been in earlier times. Although antibiotics have drastically improved the management and outcomes seen in therapy of acute osteomyelitis, they have had substantially less impact on therapy of patients with chronic osteomyelitis. The mainstay of therapy for chronic osteomyelitis is primarily surgical with antibiotics serving as an adjunct.

Acute vs. Chronic Osteomyelitis
    Origin Age Group Therapy  
  Acute Osteomyelitis Hematogenous Children Good response to antibiotics;
limited surgery may be necessary
 
  Chronic Osteomyelitis Post-traumatic Adults Minimal response to antibiotics;
aggressive surgery often necessary
 

 

Differences in approaches to acute osteomyelitis and chronic osteomyelitis are necessary because of differences in the histopathology of the diseased bones. Acute osteomyelitis is associated with intense inflammation, but, if treated promptly and aggressively, can be cured before the hallmark of chronic osteomyelitis – dead bone (a sequestrum) – develops.

Osteomyelitis that occurs at the site of trauma is, by definition, "chronic" from the onset, since dead bone, caused by the trauma that introduced the infection, is already present. As such, therapy of any such osteomyelitis must be focused upon elimination of devitalized and poorly vascularized tissue (sequestra and scars) and appropriate antimicrobial therapy. Instituting one without the other will not likely lead to a successful outcome.

One of the major obstacles to eliminating all dead, infected bone has been the necessity of preserving function. In attempting to eliminate the infection, we must strive to preserve function of the limb. However, for over 50 years now, we have had the means to eliminate dead bone and remodel the remaining bone to fill the gap. The procedure and the device most commonly used to accomplish this are named after Dr. Gavriil Ilizarov, the Russian physician who discovered this approach.

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