Chapter

Chronic long bone osteomyelitis

Peter Calder

in Oxford Textbook of Trauma and Orthopaedics

Second edition

Published on behalf of Oxford University Press

Published in print August 2011 | ISBN: 9780199550647
Published online April 2011 | e-ISBN: 9780199608249 | DOI: http://dx.doi.org/10.1093/med/9780199550647.003.011001

Series: Oxford Textbooks

Chronic long bone osteomyelitis

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Pathological features of chronic osteomyelitis

Necrotic bone

Compromised soft tissues with reduction in vascularity

Ineffective host response

Sequestrum formation

New bone formation from viable periosteum and endosteum

Formation of involucrum:

Treatment principles in chronic osteomyelitis

Surgical debridement – remove all devitalized necrotic tissue

Dead space management:

Soft tissue defect – avoid healing by secondary intention. Consider local and free flaps

Bone defects – small structural with autologous bone graft, consider Papineau ‘open bone grafting’ where free tissue transfer is not an option, distraction osteogenesis with bifocal and bone transport for large defects including fibula transfer

Bone stability – movement needs to be eliminated

Antibiotic therapy – based on culture and sensitivity, local administration with PMMA beads or collagen sponge, Lautenbach procedure in resistant cases.

Chapter.  2347 words.  Illustrated.

Subjects: Trauma and Orthopaedic Surgery ; Rheumatology ; Infectious Diseases

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