Osteomyelitis of the skull.

This retrospective study includes 18 patients who underwent 28 admissions for treatment of osteomyelitis of the skull. Each admission was reviewed separately. Systemic symptoms were rare and signalled the presence of an associated collection of pus. Films of the skull, polytomography and bone scans were all useful in establishing the diagnosis, whereas white blood cell count, erythrocyte sedimentation rate and brain scans were of little value. Complete surgical debridement was found to be of significantly greater value than limited surgical debridement. The surgical results appeared to be improved when surgery was followed by long courses of antibiotics. Each patient who received complete surgical debridement followed by at least six weeks of antibiotic therapy was cured.     

Osteomyelitis of the calcaneum.

We reviewed 52 cases of osteomyelitis of the calcaneum. The clinical symptoms and signs were well defined, but different and less dramatic than those of long-bone osteomyelitis. Blood cultures were positive in 41% of cases and tissue cultures in 91%. Routine haematological tests were of little value, and radiological changes were often delayed, and were absent in 12%. With early diagnosis, treatment with antibiotics alone was usually effective, but complications and chronic disease were more likely if there was delay. Early diagnosis is the key to successful treatment. We describe a new physical sign and consider that diagnosis is almost always possible by clinical methods.     

Osteomyelitis of the ribs in Ibadan.

Sixteen patients with pyogenic osteomyelitis of the ribs are reported; ages ranged from 3 months to 42 years and 10 were female. Right sided ribs were affected in 10 cases and single ribs in 12. Antecedent causes included empyema thoracis (56%) and blunt chest trauma (19%). Fourteen out of 16 patients presented with discharging chest wall sinuses and five patients had associated swellings on the chest wall. The duration of symptoms ranged from two to 36 months. The most common microorganism isolated was Staphylococcus aureus (50%). Rib excision (with drainage of the empyema in two cases) was curative in all 16 cases in this study.     

Osteomyelitis of the skull base.

Three cases of osteomyelitis of the skull base with associated problems in diagnosis and therapy are discussed. Patients with atypical skull base osteomyelitis are difficult to diagnose as they have no ear abnormalities, but they often develop multiple cranial nerve deficits mimicking symptoms of a posterior fossa mass. We conclude that computed tomographic scans, magnetic resonance imaging studies, bone scans indium-labeled white blood cell scans, and gallium scans are useful in making the diagnosis. A biopsy of the bony lesion often is needed to identify the causative organism and to rule out a tumor. Intravenously administered antibiotics are the mainstay of therapy and should be continued until 1 week after the gallium scan shows no abnormalities. Follow-up gallium scans then are done at 1 week and 3 months after the cessation of antibiotic therapy to search for a recurrence.     

Osteomyelitis. The Ilizarov perspective.

It is evident that Professor Ilizarov has devised some remarkable strategies for dealing with chronic osteomyelitis. In summary, his methods include: Extensive debridement and intercalary bone transport. Oblique osteotomy through multiloculated cavitary osteomyelitis in intact bone. Elimination of large cavities by gradual displacement of one cortical wall. The role that these techniques will play in the future of osteomyelitis surgery remains to be determined by careful clinical and experimental research.     

Osteomyelitis of the clavicle. A case report.

Osteomyelitis of the clavicle is a rare complication of subclavian vein catheterization. The authors report the case of a patient with osteomyelitis in the right clavicle after subclavian venipuncture.     

Osteomyelitis following puncture wounds of the foot in children.

Review of the laboratory and clinical findings and treatment of eight patients with osteomyelitis of the foot after puncture wounds revealed that: 1) osteomyelitis after puncture wounds is a infrequent but potentially serious complication, with significant morbidity; 2) osteomyelitis is frequently preceded by inadequate primary care for simple puncture wounds, and when treatment is appropriate, osteomyelitis usually can be avoided; 3) P. aeruginosa is the most commonly recovered organism; 4) the clinical presentation is characterized by a lack of systemic toxicity, paucity of laboratory abnormalities, and evidence of a localized infection process and the patient may be asymptomatic for a few days to several months after the injury before presentation of the osteomyelitis; and 5) once the infection has become established, treatment must be aggressive, including surgical debridement.     

Osteomyelitis

Osteomyelitis of the jaws differs significantly from osteomyelitis at other skeletal sites. These differences are due to a different group of pathogens, the presence of teeth, a different blood vessel density, an oral environment and a thin mucosa as opposed to skin. These differences are also related in the confusing array of terms used to describe the different forms of jaw osteomyelitis. Despite the availability of an antibiotic therapy and an improved dental and medical provision, the development of microorganisms resistant to commonly used antibiotics and the increased number of immunocompromised patients have led again to an increase of cases refractory to standard treatments. Especially older patients with risk factors such as vascular diseases, diabetes mellitus and poor oral hygiene can be affected.     

Osteomyelitis

Zusammenfassung Ein neues Therapieprinzip als Alternative zur Saugspül-Drainage wird vorgestellt —Gentamicin-P.M.M.A.-Kugeln und -Ketten. Sie ermöglichen — nach exakter chirurgischer Sanierung —eine hochdosierte lokale Behandlung infizierter Areale. Operationsergebnisse und bisherige Verlaufskontrollen nach durchschnittlich 14 Monaten bei 51 Fällen sind ermutigend, Langzeitergebnisse stehen noch aus.

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OsteomyelitisFirst Experiences with P.M.M.A. Chains and Balls

Summary A new therapeutic principle in the treatment of osteomyelitis is introduced—as an alternative to Suction Drainage-, i.e. Gentamycin P.M.M.A. chains. After exact surgical debridement a local therapy with high concentrations of antibiotic is possible. Results of the performed operations on 51 patients are encouraging after 14 months. Long term results are as yet not known.

     

Osteomyelitis

Despite promising advances in antibiotic and surgical therapy osteomyelitis remians a severe disease with a high morbidity. Nowadays it occurs mainly after traumata. Typical clinical manifestations are signs of local infection, non-healing wounds, pathological fractures or loosening of orthopedic implants. Besides the clinical judgement the diagnosis is consolidated by imaging procedures, histopathological and microbiological examinations. Ideally, the treatment plan is based on an interdisciplinary approach. Besides the radical surgical debridement a test appropriate antibiotic therapy is essential. Defect reconstruction after surgical debridement and optimization of local microcirculation is essential to preserve limbs and to obtain a good functional result. Microsurgical free tissue transfer is often necessary to achieve healing. An optimal therapeutic management with stable long-term clinical results can be achieved by the interaction of different surgical and medical disciplines.     

70. Abakterielle Osteomyelitis durch Metallose

Zusammenfassung Nach Osteosynthesen kann durch Korrosion der implantierten metallischen Hilfsmittel eine reaktive Entzündung am Knochen ausgelöst werden, die sich weder klinisch noch röntgenologisch wesentlich von einer bakteriellen Osteomyelitis unterscheidet. Auch einer solchen abakteriellen, durch Metallose bedingten posttraumatischen Osteomyelitis kommt gelegentlich ein echter Krankheitswert zu, so daß eine entsprechende Behandlung, nämlich die Entfernung des korrodierten Osteosynthesematerials mit Ausräumung des metallotischen Gewebes erforderlich wird.

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Abacterial osteomyelitis due to metallosis

Summary Corrosion of metal implants used for internal fixation can cause a reactive inflammation of the bone which cannot be differentiated from bacterial osteomyelitis by clinical and radiological methods of examination. Post-traumatic abacterial osteomyelitis of this type may be of clinical importance and requires treatment consisting in the removal of the corroded implant and the adjacent metallotic tissue.

     

63. Pathogenese der posttraumatischen Osteomyelitis

Zusammenfassung Die posttraumatische Osteomyelitis entsteht als Folge einer exogenen Keimbesiedlung von Knochengewebe, heute in den meisten Fällen im Zusammenhang mit einer offenen Fraktur oder mit einem operativen Eingriff am Knochengewebe. Die pathogenetischen Faktoren, Ausmaß der Gewebeschädigung, mechanische Unruhe im Verletzungsbereich, Virulenz der pathogenen Erreger und Funktion der spezifischen und unspezifischen Abwehrvorgänge, werden besprochen. Auf histologisch systematisierbare Befunde wird aufmerksam gemacht.

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Pathogenic factors in post-traumatic osteomyelitis

Summary Post-traumatic osteomyelitis results from an exogenous bacterial infection usually associated with an open fracture or bone surgery. The following pathogenic factors are described: extent and degree of the damage, the instability, the virulence of bacteria, the efficiency of the immunological defense and unspecific resistance systems. A histological classification is described.

     

Osteomyelitis

Introduction

Osteomyelitis is a challenging diagnosis for every patient because of its protracted treatment process. Very experienced orthopaedic surgeons are needed to diagnose and treat this bacteria-related severe disorder in a right and proper way.

Materials and methods

Different treatment options are possible for osteomyelitis at any stage: antibiotics in the acute and chronic stage for conservative treatment or radical debridement, bone fenestration, reaming, bone troughing, the Masquelet-technique, segmental resection with callus distraction, bone grafting and even amputation as surgical therapy.

Results

Depending on different stages of the disease, there are good results with every technique available—on condition that radical debridement was performed. The complication rate is remarkable so that soft tissue defects should be assessed by using flaps to close the wounds in early stages.

Conclusions

The treatment of osteomyelitis should be done in centres with expertise in the treatment of this challenging disease. Different methods should be offered by surgeons and individual treatment concepts acquired together with the patient. The treatment of complications like soft tissue defects should be provided in the same centre and performed in short time lag to the prior surgery. The cooperation of the patient and surgeons of different specialities is mandatory in these cases.     

66. Therapie der traumatischen Osteomyelitis

Zusammenfassung Bei der Behandlung der traumatischen Osteomyelitis müssen die Ausbreitungswege und die Entwicklungsstadien der Infektion beachtet werden. Mit Ausnahme der drohenden Infektion (allgemeine Antibiotics) ist die Behandlung chirurgisch. Bei akuter postoperativer Manifestation bilden Herderöffnung, Spüldrainage und Belassen stabiler Implantate das Verfahren der Wahl. Zur Sanierung der chronischen Stadien stehen knochenplastische Eingriffe im Vordergrund. Das Stabil-Halten oder die erneute Stabilisierung der Infektionsherde ist in allen Fällen von grundsätzlicher Bedeutung. Alle für Indikation und Behandlung wesentlichen Fakten werden erläutert.

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Treatment of exogenous osteomyelitis

Summary In the treatment of traumatic osteomyelitis it is advisable to pay due respect to the route and stage of progression of the infectious process. Except in the case of imminent infection (systemic antibiotics) the condition is treated by surgery. In cases of acute postoperative manifestation the treatment of choice consists in opening of the infected area, irrigation drainage and maintenance of stable implants. In cases of chronic infection osteoplastic surgery is necessary. In all cases, maintenance of stability or restabilization is of the utmost importance. All necessary data on indication and treatment are given.