Long bone osteomyelitis

Abstract

Osteomyelitis is a complex disease that is often associated with high morbidity and considerable health care costs. Bacteremia, contiguous focuses of infection, penetrating trauma, or surgery are the major predisposing factors for this infection. Bone necrosis and bone destruction occur early in the course of osteomyelitis, leading to a chronic process and eliminating the host's ability to eradicate the pathogens. The presence of poorly vascularized tissues, the adherence to bone structures and implants, and a slow bacterial replication rate are recognized as important factors for the persistence of the infection. Treatment of osteomyelitis is particularly challenging and involves adequate antimicrobial therapy and surgical debridement of all necrotic bone and soft tissues. Antibiotic treatment is usually started on an empiric basis and then modified according to the results of cultures and sensitivity tests. Surgical treatment consists of debridement, obliteration of dead space, adequate soft tissue coverage, restoration of blood supply, and stabilization.

Population pharmacokinetics of clindamycin orally and intravenously administered in patients with osteomyelitis

“…It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue and periosteum. The most common treatments for osteomyelitis are antibiotics and surgery to remove portions of bone that are infected or dead [1]. For optimal results, antibiotic therapy must be started early, with antimicrobial agents administered for at least 4 to 6 weeks.…”

Gatifloxacine-loaded PLGA and β-tricalcium phosphate composite for treating osteomyelitis

“…Chronic osteomyelitis is an intractable infection of the bone associated with the destruction of bone tissues and vascular channels [1][2][3][4] . The destruction of vascular channels leaves a portion of dead and infected bone (sequestrum) detached from the adjoining healthy bone and surrounded by avascular soft tissue.…”

Musculoskeletal infection imaging: Past, present, and future

“…Classically, osteomyelitis is divided into three different clinical entities (acute, subacute, and chronic) according to the evolution of the infection in terms of time [2••,3,4] but can also be classified by pathogenesis (hematogenous spread, contiguous spread, or direct implantation) or by anatomic involvement of the bone (medullar, superficial, localized, or diffuse) [2••, 3,5]. Understanding these stages allows an accurate approach to the use of imaging to aid the diagnosis.…”

“…When an encasing sheath of new periosteal bone develops around the sequestrum, it is called "involucrum." Sometimes necrotic bone and debris from the sequestrum exits across the involucrum through an opening, termed "cloaca," allowing pus and sequestra to drain along sinus tracts to the skin [1,2••, [3][4][5][6].…”

“…The major drawback of CT is the scatter phenomenon (artifact) produced by nearby metal objects, such as an orthopedic device, which results in significant loss of image resolution [3,5]. On the other hand, it is a main choice for image-guided procedures, such as biopsies or percutaneous aspiration of collections [2••].…”