A Seminar On

CHRONIC OSTEOMYELITIS
By Y.Bharath Kumar

. or a sequestrum. relatively a vascular bone covered by a thickened periosteumand scarred muscle and subcutaneous tissue.INTRODUCTION       Chronic osteomyelitis is difficult to eradicate completely. This a vascular envelope of scar tissue leaves systemic antibiotics essentially ineffective. infected granulation tissue. Intermittent acute exacerbations may occur for years and often respond to rest and antibiotics. Systemic symptoms may subside. but one or more foci in the bone may contain purulent material. The hallmark of chronic osteomyelitis is infected dead bone within a compromised soft-tissue envelope. The infected foci within the bone are surrounded by sclerotic.

less aggressive alternatives should be considered. . and sinus track cultures usually do not correlate with cultures obtained at bone biopsy.     In chronic osteomyelitis. especially in compromised patients. For this patient. however. including chronic osteomyelitis of the femur. Multiple organisms may grow from cultures taken from sinus tracks and from open biopsy specimens of surrounding soft tissue and bone. Surgery is not always the best option. secondary infections are common. Eradication of chronic osteomyelitis generally requires aggressive surgical excision combined with effective antibiotic treatment. who might not survive the extensive surgical stress required to eradicate the disease. Consider an ambulatory immunocompromisedhost with multiple medical problems. Limited surgical débridement combined with suppressive antibiotics and nutritional support may limit the frequency of sinus drainage and pain in these difficult cases.

based on physiological and anatomical criteria.   Physiological Class: Class A hosts have a normal response to infection and surgery. When the results of treatment are potentially more damaging than the presenting condition. the patient is considered a class C host.   . Class B hosts are compromised and have deficient wound healing capabilities. to determine the stage of infection.CLASSIFICATION  Cierny and Mader developed a classification system for chronic osteomyelitis.

superficial osteomyelitis is limited to the surface of the bone.  Type III is a localized infection involving a stable. and infection is secondary to a coverage defect.  Type I. well-demarcated lesion characterized by full-thickness cortical sequestration and cavitation (in this type. complete débridement of the area would not lead to instability). Anatomical Class:  Anatomical criteria consist of four types. a medullary lesion. either at presentation or after appropriate treatment . is characterized by endosteal disease.  In type II.  Type IV is a diffuse osteomyelitic lesion that creates mechanical instability.

Cierny and Mader Staging System for Chronic Osteomyelitis AnatomicalType I II III IV Medullary Superficial Localized Diffuse Cortical Cortical surface sequestrum Endostealdisease infected that can be because excised of without coverage compromising defect stability Features of I. or poor prognosis for cure .Table -. prohibitive morbidity anticipated. and III plus mechanical instability before or after débridement Physiological Class A host B host C host Normal Compromised Prohibitive Immunocompetent Local (B) or systemic with good local vascularity (S) factors that compromise immunity or healing Minimal disability. II.

Diagnosis .