Fidela Firwan Firdaus 20080310018

Chronic

osteomyelitis:

An osseus infection that has progressed to bone necrosis and sequestrum formation.

Symptoms History Physical examination Laboratory tests

Vague/ unclear chronic pain, chills, low grade fever local swelling and drainage normal leukocyte count, elevated erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) levels

Imaging modalities for detecting the infection

Diagnosis

X-ray, CT scan, MRI

medical history, laboratory findings, different imaging techniques

Eliminate differential diseases

Guide the antimicrobial drug choice

Technetium-99m labeled leukocyte imaging

Bone cultures

Divided in 2 basic steps: Debridement and obliteration of the subsequent dead space by soft tissue. Removal of hardware or fracture stabilization.

Includes excision of all sequestra along with any infected bone or soft tissue obliteration of residual dead space Recurrence rate 30% because insufficient debridement To decrease recurrence, requires: segmental resection application of external fixator immediate or delayed metaphyseal corticotomy

 The

best option for reconstructing chronic osteomyelitic wounds muscle flaps The most common muscles used in freetransfer procedures latissimus dorsi and rectus abdominis The advantages of a muscle flap:

good blood flow antibiotic release oxygen tension

 Post-operative

antibiotic decided by culture and sensitivity results. Widely used protocol in adults antibiotics intravenous for 46 weeks There are no clinical studies or documented records indicating the superiority of the 46week course of antibiotics over other durations.

 The

advantage:

the beads fill dead space produced by debridement They provide local antibiotic concentrations that are much greater than the minimum inhibitory concentration for most pathogens isolated in orthopedic infections.

 Terms:

treatment modalities of chronic osteomyelitis in the lower extremities, combined with antibacterial agents/ antibiotic. Articles published: 1955 - 2008.

Animal studies:
need more studies on angiogenesis and revascularization

Human studies:
shorter duration of antimicrobial treatment and well-vascularized flap coverage possible alternative guideline for treating chronic osteomyelitis in the lower extremities

No evidence that prolonged parenteral antibiotics will penetrate the necrotic bone. Studies that we need more in chronic osteomyelitis:
duration of antibiotic treatment clarify the role of angiogenesis