Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 9/2013

01-09-2013 | Orthopaedic Surgery

Osteomyelitis

Authors: Aidan Hogan, Volkmar G. Heppert, Arnold J. Suda

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2013

Login to get access

Abstract

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.
Literature
1.
go back to reference Heppert V, Glatzel U, Schmickal T, Wentzensen A (2002) External fixator and soft tissue damage. Trauma Berufskrankh 4(4):431–439 Heppert V, Glatzel U, Schmickal T, Wentzensen A (2002) External fixator and soft tissue damage. Trauma Berufskrankh 4(4):431–439
2.
go back to reference Bühler M, Engelhardt M, Schmidt H (2003) Septische postoperative Komplikationen. Springer Verlag, Germany Bühler M, Engelhardt M, Schmidt H (2003) Septische postoperative Komplikationen. Springer Verlag, Germany
3.
go back to reference Schnettler R, Steinau H-U (2010) Septic bone and joint surgery. Georg Thieme Verlag, Germany Schnettler R, Steinau H-U (2010) Septic bone and joint surgery. Georg Thieme Verlag, Germany
4.
go back to reference Hendrich C, Frommelt L, Eulert J (2004) Septische Knochen—und Gelenkchirurgie. Springer, Berlin Hendrich C, Frommelt L, Eulert J (2004) Septische Knochen—und Gelenkchirurgie. Springer, Berlin
5.
go back to reference Masquelet AC (1995) An Atlas of flaps in limb reconstruction. Martin Dunitz Ltd. , London Masquelet AC (1995) An Atlas of flaps in limb reconstruction. Martin Dunitz Ltd. , London
7.
go back to reference Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of 1025 open fractures of long bones. JBJS 58(4):453–458 Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of 1025 open fractures of long bones. JBJS 58(4):453–458
8.
go back to reference Bonnaire F, Hohaus T, Cyffka R, Lein T (2002) Knocheninfektionen. Unfallchirurg 73:716–733CrossRef Bonnaire F, Hohaus T, Cyffka R, Lein T (2002) Knocheninfektionen. Unfallchirurg 73:716–733CrossRef
11.
go back to reference Lutter C, Unger K, Heppert V, Simon R, Hitzigrath C, Germann G (2010) Chronische Osteitis der unteren Extremität. Unfallchirurg 113(5):386–393CrossRef Lutter C, Unger K, Heppert V, Simon R, Hitzigrath C, Germann G (2010) Chronische Osteitis der unteren Extremität. Unfallchirurg 113(5):386–393CrossRef
12.
go back to reference Elek SD, Conen PE (1957) The virulence of Staph. Pyogenes for man. A study of the problems of wound infection. Br J Exper Path 38:573 Elek SD, Conen PE (1957) The virulence of Staph. Pyogenes for man. A study of the problems of wound infection. Br J Exper Path 38:573
13.
go back to reference Diefenbeck M, Hofmann GO (2003) Behandlungsstrategie beim Frühinfekt nach operativer Frakturversorgung. Trauma und Berufskrankheit 5(Suppl 2):309–312CrossRef Diefenbeck M, Hofmann GO (2003) Behandlungsstrategie beim Frühinfekt nach operativer Frakturversorgung. Trauma und Berufskrankheit 5(Suppl 2):309–312CrossRef
14.
go back to reference Wagner C, Hänsch GM, Wentzensen A, Heppert V (2006) Die Implantat assoziierte posttraumatische Osteitis: bakterielle Biofilme und Infektabwehr als Protagonisten der lokalen Entzündungsreaktion. Der Unfallchirurg 109:761–769PubMedCrossRef Wagner C, Hänsch GM, Wentzensen A, Heppert V (2006) Die Implantat assoziierte posttraumatische Osteitis: bakterielle Biofilme und Infektabwehr als Protagonisten der lokalen Entzündungsreaktion. Der Unfallchirurg 109:761–769PubMedCrossRef
15.
go back to reference Wagner C, Heppert V, Hänsch G (2007) The immune defence against bacterial biofilms: consequence for the host. Infections of the hand and upper limb. In: Hrsg K. Malizos, Soucacis P (eds) Paschalidis Medical Publications Ltd. Greece Wagner C, Heppert V, Hänsch G (2007) The immune defence against bacterial biofilms: consequence for the host. Infections of the hand and upper limb. In: Hrsg K. Malizos, Soucacis P (eds) Paschalidis Medical Publications Ltd. Greece
16.
go back to reference Arens S, Hansis M (2001) Risiko der posttraumatischen Osteitis bei Osteosynthesen. Trauma und Berufskrankheit 3(Supplemen 4):487–490CrossRef Arens S, Hansis M (2001) Risiko der posttraumatischen Osteitis bei Osteosynthesen. Trauma und Berufskrankheit 3(Supplemen 4):487–490CrossRef
17.
18.
go back to reference Cierny G III (1990) The classification and treatment of adult osteomyelitis. Surgery of musculosceletal systems (CM Evarts), 2nd edn. Churchill Livingstone, inc., New York Cierny G III (1990) The classification and treatment of adult osteomyelitis. Surgery of musculosceletal systems (CM Evarts), 2nd edn. Churchill Livingstone, inc., New York
19.
go back to reference Cierny G III, Zorn KE (1994) Segmental tibial defects. Comparing conventional and Ilizarov methodologies. Clin Orthop Relat Res 301:118–123PubMed Cierny G III, Zorn KE (1994) Segmental tibial defects. Comparing conventional and Ilizarov methodologies. Clin Orthop Relat Res 301:118–123PubMed
20.
go back to reference Cierny G III (1999) Infected tibial nonunions (1981–1995). The evolution of change. Clin Orthop Relat Res 360:97–105PubMedCrossRef Cierny G III (1999) Infected tibial nonunions (1981–1995). The evolution of change. Clin Orthop Relat Res 360:97–105PubMedCrossRef
21.
go back to reference Steinau HU, Germann G (1991) Plastisch-rekonstruktive Mikrochirurgie zur posttraumatischen Infektions-prophylaxe und -therapie. Chirurg 62:852PubMed Steinau HU, Germann G (1991) Plastisch-rekonstruktive Mikrochirurgie zur posttraumatischen Infektions-prophylaxe und -therapie. Chirurg 62:852PubMed
22.
go back to reference Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41(1):27–37PubMedCrossRef Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41(1):27–37PubMedCrossRef
23.
go back to reference Heppert V (2009) Weichteilmanagement und knöcherne Rekonstruktion. Trauma Berufskrankh 11:211–216CrossRef Heppert V (2009) Weichteilmanagement und knöcherne Rekonstruktion. Trauma Berufskrankh 11:211–216CrossRef
24.
go back to reference Neut D, van de Belt H, Stokroos J, van Horn J (2001) Biomaterial-associated infection of gentamycin-loaded PMMA beads in orthopaedic revision surgery. J Antimicrob Chemother 47(6):885–891PubMedCrossRef Neut D, van de Belt H, Stokroos J, van Horn J (2001) Biomaterial-associated infection of gentamycin-loaded PMMA beads in orthopaedic revision surgery. J Antimicrob Chemother 47(6):885–891PubMedCrossRef
25.
go back to reference Gaskill TR, Urbaniak JR, Atdridge JM (2009) Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg Am 91(8):1861–1867PubMedCrossRef Gaskill TR, Urbaniak JR, Atdridge JM (2009) Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg Am 91(8):1861–1867PubMedCrossRef
26.
go back to reference Strauch B, Yu HL (1993) Atlas of microvascular surgery (Hrsg). Thieme Verlag Stuttgart, New York Strauch B, Yu HL (1993) Atlas of microvascular surgery (Hrsg). Thieme Verlag Stuttgart, New York
27.
go back to reference Heppert V (2002) Osteitis Unterschenkel. Trauma Berufskrankh 4(1):114–120CrossRef Heppert V (2002) Osteitis Unterschenkel. Trauma Berufskrankh 4(1):114–120CrossRef
28.
go back to reference Heppert V (2002) Prinzipien der operativ-chirurgischen Therapie der Osteitis. Trauma Berufskrankh 4(3):321–328CrossRef Heppert V (2002) Prinzipien der operativ-chirurgischen Therapie der Osteitis. Trauma Berufskrankh 4(3):321–328CrossRef
Metadata
Title
Osteomyelitis
Authors
Aidan Hogan
Volkmar G. Heppert
Arnold J. Suda
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 9/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1785-7

Other articles of this Issue 9/2013

Archives of Orthopaedic and Trauma Surgery 9/2013 Go to the issue