Chronic pyogenic osteomyelitis

Chronic pyogenic osteomyelitis is a continuation of acute pyogenic osteomyelitis; symptoms are usually localized, often intractable and may not heal for years or decades. Treatment generally combines surgery and medication, i.e. improving general condition, controlling infection and surgical management. Because of prolonged bed rest from serious illness, especially after hematogenous acute attacks, general condition greatly needs improvement; besides antibiotics, nutrition, transfusion when needed, surgical drainage and other treatment are used.

Common Symptoms

Sequestrum; bone marrow damage; muscle atrophy

Causes

Untimely or incomplete treatment lets inflammation recur whenever resistance drops, causing acute attacks. The lesion may last years or decades; extensive local scarring and sinus with poor circulation favor bacterial growth while antibiotics cannot reach. The local sinus discharges intermittently and long fails to heal. Chronic pyogenic osteomyelitis follows untimely or incomplete treatment of acute osteomyelitis, causing poor drainage and many sequestra left in bone. Comminuted fracture or severe trauma with retained foreign bodies not removed in time causes an encapsulated dead space with sequestra or shell fragments.

Treatment

Surgery, medication, supportive treatment

Prevention

(1) Early antibiotics after trauma. Systemic antibiotics mainly prevent spread and sepsis, while early local use definitively prevents wound infection; data show low infection rates among Japanese soldiers at Pearl Harbor due to timely debridement and local sulfonamides; in the Vietnam War the overall wound infection rate was 40%, but only 17% among soldiers given local oxytetracycline 100mg promptly; experiments show oxytetracycline applied within 5 minutes of a contaminated crush wound is far more effective than application at 4 hours or later, so local antibiotics should be used as early as possible before firearm debridement; aminoglycosides such as kanamycin, gentamicin and tobramycin are advocated. (2) Debridement. Aim for early thorough debridement; if antibiotics were given early, debride even without signs of infection at 24-48 hours; an infected wound should only be drained, removing obvious foreign bodies and necrotic tissue simply. Account for firearm trauma: do not stop at the primary tract; enlarge the incision and resect the tract and surrounding crushed area; remove foreign bodies when possible, reduce fractures, do not remove large bone fragments, avoid primary internal fixation, achieve hemostasis and repair major vessels; tendon and nerve injury may be repaired secondarily. In field conditions thorough debridement is hard, so wounds are not primarily closed; do delayed primary or secondary closure as appropriate. Delayed primary closure at 4-7 days without infection or granulation gives scarless healing and is safe. Also, emphasize personal hygiene and bathing to prevent boils.

Recommended Department

It is recommended to visit the orthopedic surgery department; before the visit you may first book an appointment and connect with experts through this platform.

Warm reminder: The above information is provided for health education reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek care at a regular hospital in time.