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CME 4: October, November, December 2004
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The Journal of Bone and Joint Surgery (American) 86:2305-2318 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Current Concepts Review

Osteomyelitis in Long Bones

Luca Lazzarini, MD1, Jon T. Mader, MD2 and Jason H. Calhoun, MD3

1 Infectious Disease Unit, Department of Internal Medicine, San Bortolo Hospital, Viale Rodolfi 47, 36100 Vicenza, Italy
2 Deceased
3 Department of Orthopaedic Surgery, University of Missouri, MC213, DC053.00, One Hospital Drive, Columbia, MO 65212. E-mail address: calhounj{at}health.missouri.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Osteomyelitis in long bones remains challenging and expensive to treat, despite advances in antibiotics and new operative techniques.

Plain radiographs still provide the best screening for acute and chronic osteomyelitis. Other imaging techniques may be used to determine diagnosis and aid in treatment decisions.

The decision to use oral or parenteral antibiotics should be based on results regarding microorganism sensitivity, patient compliance, infectious disease consultation, and the surgeon's experience. A suppressive antibiotic regimen should be directed by the results of cultures.

Standard operative treatment is not feasible for all patients because of the functional impairment caused by the disease, the reconstructive operations, and the metabolic consequences of an aggressive therapy regimen.

Operative treatment includes débridement, obliteration of dead space, restoration of blood supply, adequate soft-tissue coverage, stabilization, and reconstruction.


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