Orthopedics and Traumatology

​

Bone infection in its cortical portion   and in its medullary content, regardless of its cause. Osteomyelitis is more common in developing countries. Its most common causes are traumatic (due to the trauma itself or after surgery), hematogenous (infections in other areas of the body can be transported via the circulatory system / bloodstream and another infectious focus starts, in this case, in bones and joints.

​

In children, the hematogenous route is the most common, with the first decade of life being the most common (1:5000 in children under 13 years of age. In adults, traumatic causes (exposed fractures or high-energy trauma) or post-traumatic events. Orthopedic surgeries are the most common.

​

Improvements in the quality and options of antibiotics (greater specificity against isolated and identified bacteria) led to a significant drop in mortality. 

​

The progression of bone infection depends on the relationship between the host (who has the bone infection and is "hosting" the offending microorganism (usually bacteria) and the virulence (aggressiveness) of the infecting microorganism. Bacteria are the most common causative agents. immunosuppression (whether by medication or other diseases) may have more difficulty controlling the bone infection and its progression. 

​

As for the time, osteomyelitis can be acute, subacute or chronic. When the infection continues once the acute stage passes, we call it chronic osteomyelitis. The presence of a residual focus of infection, necrotic bone, poor condition of the soft tissues can sustain the favorable environment for the bacteria and the infection persists despite the use of antibiotics. Symptoms can be exacerbated by "mimicry" the acute stage and cause systemic symptoms (fever, malaise, lack of appetite, distant infections, sepsis, multiple organ failure). When there is a fistula (active output of pus through a fixed, permanent or intermittent path), the factor of being expelling purulent material, laboratory tests have little or no modification. Therefore, the behavior of the infection has to be interpreted and monitored. 

​

Long bones (tibia and femur) are the most affected, around 50% of cases. 

 

Among numerous classifications for osteomyelitis, one of the most used for understanding bone infection is the Cierny-Mader classification. 

​

Chronic osteomyelitis is controlled with antibiotic therapy, but the cure of the infection is obtained through surgical resection of the infected segment and antibiotic therapy is an important adjuvant, mainly to minimize systemic complications.

 

The treatment goals are: 

1) Eradicate the infection. Surgery leaving infection-free margins in the remaining tissue.

2) Preserve soft tissue coverage (skin, muscle).

3) Obtain a consolidated, stable, aligned bone segment, with restored length, allowing load function and preserved movements.​

​

Osteomyelitis remains a major medical challenge. Disease that brings severe functional disability, social isolation, high rate of depression associated with its multiple aspects of the disease and its negative influence on quality of life. Aggressive treatment involving its multifactorial aspects, meticulous surgical and drug planning, and disciplined involvement are necessary for good clinical outcomes.