Treatment of acute osteomyelitis

It has been well established that sequestered abscesses demand surgical drainage. However, areas of simple inflammation without abscess formation can be treated with antibiotics alone. Nade's principles for the treatment of acute hematogenous osteomyelitis: 1. an appropriate antibiotic will be effective before pus formation; 2. antibiotics will not sterilize avascular tissues or abscesses and such areas require surgical removal; 3. if such removal is effective, antibiotics should prevent their reformation and therefore primary wound closure should be safe; 4. surgery should not further damage already ischemic bone and soft tissue; 5. antibiotics should be continued after surgery. general supportive care--- IV fluids, analgesics, and comfortable positioning of the affected limb. If no abscess (by subperiosteal or bone marrow aspirate) then intravenous antibiotics based on the gram stain should be started. Empirical antibiotic coverage for the most likely infecting organism should be started if gram stain is negative, and the patient then should be carefully monitored. The CRP should be checked every 2 to 3 days. If no appreciable clinical response within 24 to 48 hours, then occult abscesses must be sought and surgical drainage considered.

Surgery for acute osteomyeilitis Indications an abscess requiring drainage failure to improve despite appropriate IV antibiotic treatment for 48 hours. Objective to drain any abscess cavity and remove all nonviable or necrotic tissue. Surgical Procedure for acute osteomyelitis Do not exsanguinate the limb with an elastic bandage if infection is present When a subperiosteal abscess is found in an infant, several small 4 mm holes should be drilled through the cortex into the medullary canal. If intramedullary pus is found, then a small window of bone is removed. The skin is then closed loosely over drains, and the limb is splinted. The limb is protected for several weeks to prevent pathological fracture. 2 weeks IV antibiotics,4 weeks oral antibiotics