Osteomyelitis of the long bones

Abstract

Long bone osteomyelitis presents a variety of challenges to the physician. The severity of the disease is staged depending upon the infection's particular features, including its etiology, pathogenesis, extent of bone involvement, duration, and host factors particular to the individual patient (infant, child, adult, or immunocompromised). Long bone osteomyelitis may be either hematogenous or caused by a contiguous spread of infection. A single pathogenic organism is almost always recovered from the bone in hematogenous osteomyelitis; Staphylococcus aureus is the most common organism isolated. A variety of multidrug-resistant organisms of bacteria continue to be a source of concern in arresting infection. The primary weapons to treat these infections are culture-specific antibiotics, aggressive debridement, muscle flaps, and bone grafts. This article offers a basic review of the classification, etiology, epidemiology, pathogenesis, and treatment of long bone osteomyelitis.

Keywords: Osteomyelitis; antibiotics; debridement; long bones.

Figure 1

Lateral Tibia, Fibula radiograph with the arrow pointing to the osteomyelitis of the tibia of a 46-year-old woman injured in a motor vehicle accident more than 10 years before this image was taken and who suffered recurrent bouts of infection since.

Figure 2

A 32-year-old man injured in a fall suffered pilon fracture and a major infection (indicated by the arrow). He was treated with antibiotics and external fixation; however, amputation proved necessary to arrest the spread of infection.

Figure 3

(A) MRI scan of a 45-year-old woman who suffered a pilon fracture in an automobile accident and suffered from infection after the injury. The bright areas, a characteristic appearance of infection in MRI scans, are indicated by arrows. (B) In an x-ray image, the area of infection is the oval area pointed to by the arrows in the center of the distal tibia.

Figure 4

Treatment algorithm of Cierny-Mader stage 1, or hematogenous, long bone osteomyelitis. (From Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am 2004;86:2305–2318. Reprinted with permission from The Journal of Bone and Joint Surgery, Inc.)

Figure 5

Treatment algorithm of Cierny-Mader stage 1 long bone osteomyelitis associated with infection at the site of hardware. (From Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am 2004;86:2305–2318. Reprinted with permission from The Journal of Bone and Joint Surgery, Inc.)

Figure 6

Treatment algorithm of Cierny-Mader stage 2 long bone osteomyelitis. (From Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am 2004;86:2305–2318. Reprinted with permission from The Journal of Bone and Joint Surgery, Inc.)

Figure 7

Treatment algorithm of Cierny-Mader stages 3 and 4 long bone osteomyelitis. (From Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am 2004;86:2305–2318. Reprinted with permission from The Journal of Bone and Joint Surgery, Inc.)

Figure 8

(A) A 29-year-old man suffered a proximal tibial diaphyseal fracture in a motor vehicle accident and developed infection as shown by the arrow. (B) A day after irrigation and debridement surgery, the area of infection is removed as indicated by the arrow.

Figure 9

Antibiotic-impregnated beads are used in the right knee of a 75-year-old woman with an infected fracture (stabilized by internal fixation) and a knee prosthesis.