Aims. The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of surgical debridement for long bone COM, and presents the outcome of adequate debridement in a tertiary bone infection unit. Methods. We analyzed the retrospective record review from 2014 to 2020 of patients with long bone COM. All were managed by multidisciplinary infection team (MDT) protocol. Adequate debridement was employed for all cases, and no case of wide resection was included. Results. A total of 53 patients (54 bones) with median age of 45.5 years (interquartile range 31 to 55) and mean follow-up of 29 months (12 to 59) were included. In all, ten bones were Cierny-Mader type I, 39 were type III, and five were type IV. All patients were treated with single-staged management, except for one (planned two-stage stabilization). Positive microbial cultures grew in 75%. Overall, 46 cases (85%) had resolution of COM after index procedure, and 49 (90.7%) had resolution on last follow-up. Four patients (7%) underwent second surgical procedure and six patients (11%) had complications. Conclusion. We challenge the need for wide tumour-like resection in all cases of COM. Through detailed preoperative evaluation and planning with MDT approach, adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes versus radical debridement. Cite this article: Bone Jt Open 2023;4(8):643–651

Addressing bone defects is a complex medical challenge that involves dealing with various skeletal conditions, including fractures, osteoporosis (OP), bone tumours, and bone infection defects. Despite the availability of multiple conventional treatments for these skeletal conditions, numerous limitations and unresolved issues persist. As a solution, advancements in biomedical materials have recently resulted in novel therapeutic concepts. As an emerging biomaterial for bone defect treatment, graphene oxide (GO) in particular has gained substantial attention from researchers due to its potential applications and prospects. In other words, GO scaffolds have demonstrated remarkable potential for bone defect treatment. Furthermore, GO-loaded biomaterials can promote osteoblast adhesion, proliferation, and differentiation while stimulating bone matrix deposition and formation. Given their favourable biocompatibility and osteoinductive capabilities, these materials offer a novel therapeutic avenue for bone tissue regeneration and repair. This comprehensive review systematically outlines GO scaffolds’ diverse roles and potential applications in bone defect treatment. Cite this article: Bone Joint Res 2024;13(12):725–740

Aims

This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis.

Sinus-track cultures were compared prospectively with cultures from operative specimens in 55 patients with chronic bone infection. There was a total of 115 operative isolates; 102 of the sinus-track isolates were identical (88.7%), showing a specificity of 95.7% and a predictive value of 90.3%. A sinus-track specimen proved to be a reliable source for the isolation of all bacteria causing chronic bone infection except Staphylococcus epidermidis, provided that material from the depths of the sinus was aspirated by syringe from an active flowing sinus and inoculated immediately on culture media. Cotton-swab sinus specimens were unreliable for the isolation of mycobacteria, and could miss many pyogenic bacteria, or contain contaminants. Tuberculous bone infection should be suspected if there is no growth of any pyogenic bacteria or if there is growth of Staphyloccocus epidermidis alone on routine aerobic and anaerobic sinus cultures. Mycobacteria can often be identified from sinus-track culture from patients in whom operative culture, histopathology and clinical examination have failed to confirm the diagnosis of tuberculosis

We have reviewed 60 patients with primary bone infections; 21 of these (35%) had subacute osteomyelitis, a figure which supports other recent observations that this variant of bone infection is becoming more widespread. In this group open culture and biopsy were necessary in order to exclude bony malignancy, and a raised erythrocyte sedimentation rate proved a useful diagnostic aid. All the patients with acute osteomyelitis or with vertebral infection responded to primary treatment, but five of those with subacute osteomyelitis had recurrences

The purpose of this report is not to describe a new condition but to remind those who seldom see smallpox of one of its most important and easily recognised complications. Bone infection can be late, almost silent and often most unexpected. It is usually symmetrical and almost always multiple. It does not affect the spine, pelvis and ribs, but does affect the arms, hands, legs and feet. It is destructive, unpreventable and untreatable. It ends with deformity but not with loss of life. The recognition of its etiology will prevent a great deal of unnecessary and unrewarding interference with a self-limiting disease

1. The literature on acute osteomyelitis of the maxilla in infants is reviewed and the improvement in the prognosis since the introduction of chemotherapy is noted. 2. The clinical features, diagnosis, surgical anatomy, pathology, and bacteriology are discussed and the constant pathogenicity of the staphylococcus aureus stressed. It is suggested that the first deciduous molar tooth is the centre of the early bone infection, and that the infection begins in the mucosa overlying this tooth. 3. Two cases are reported. Both were caused by a penicillin-resistant staphylococcus aureus. 4. The early use of aureomycin in an attempt to abort the infection is advocated

1. A technique of closed instillation-suction for the treatment of chronic bone infection is described in which infected bone is first exposed and all necrotic material removed. Three perforated drainage tubes are inserted, and brought out through the skin some distance from the wound. The perforated parts of the tubes are laid close to the infected area and the wound closed in layers. Two of the tubes are connected to a drip bottle containing antibiotic solution, and the third to a continuous suction pump. Closed continuous instillation-suction is thus established, and has been maintained for up to six weeks. 2. The results in twelve cases are presented, two-thirds of which showed clinical resolution of the infection

Tuberculous osteomyelitis which does not involve a joint is uncommon and may fail to be diagnosed by an orthopaedic surgeon. We treated 28 lesions of tuberculous osteomyelitis in 25 patients between 1988 and 1995. The duration of symptoms was from two to 39 months, and most of our patients had been treated initially with non-steroidal anti-inflammatory drugs which failed to provide relief. Bone pain which does not promptly respond to analgesic medication is often due to infection or neoplasia.

In the early stages, when plain radiographs are normal, MRI or CT may help to localise lesions. On plain radiographs, more advanced lesions may mimic chronic pyogenic osteomyelitis, Brodie’s abscess, tumours or granulomatous lesions. Biopsy is mandatory to confirm the diagnosis, and antituberculous drugs are the mainstay of treatment. When operative findings at biopsy have the features of skeletal tuberculosis curettage of the affected bone may promote earlier healing.

Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndromes to which this disease can give rise. Extensive surgical drainage and antibiotic treatment led to recovery in all cases.

We reviewed 52 cases of osteomyelitis of the calcaneum. The clinical symptoms and signs were well defined, but different and less dramatic than those of long-bone osteomyelitis. Blood cultures were positive in 41% of cases and tissue cultures in 91%. Routine haematological tests were of little value, and radiological changes were often delayed, and were absent in 12%. With early diagnosis, treatment with antibiotics alone was usually effective, but complications and chronic disease were more likely if there was delay. Early diagnosis is the key to successful treatment. We describe a new physical sign and consider that diagnosis is almost always possible by clinical methods.

1. Five new cases of pyogenic osteomyelitis of the patella are reported.

2. The clinical features are reviewed and the diagnostic pitfalls enumerated.

1. Recent published reports of neonatal osteomyelitis in long bones are reviewed.

2. Six further cases are described.

3. The source of infection is usually the skin or the umbilicus, and the common organisms are the haemolytic streptococcus and staphylococcus aureus.

4. Cases fall into two groups: in one the patient is acutely ill with septicaemia and the bone lesion is of secondary importance; in the other the general condition is well maintained even though there may be multiple bone lesions.

5. Sequestration is uncommon; but when it occurs it prevents the rapid healing that is usually observed after drainage.

6. The most important complication is suppurative arthritis, which may lead to total destruction of a joint.

7. It is probable that the lowered mortality from infantile septicaemia will be matched by a corresponding increase in the cases of acute osteomyelitis encountered in clinical practice.

1. Acute osteomyelitis is defined.

2. An analysis of 113 cases is given.

3. An effective programme of treatment was evolved from experience over a period of nine years.

4. Recommendations regarding a programme of treatment are given.

1. Sixty-seven patients with subacute haematogenous osteomyelitis are reported.

2. The benign nature of the disease is noted.

3. The clinical types of infection are reported, with regard to the site of the lesion.

4. The treatment is described.

1. Three cases of osteomyelitis of a metatarsal sesamoid bone are described.

2. The diagnosis should be considered in patients with acute pain under the first metatarsophalangeal joint, particularly if the temperature is elevated.

3. Failure ofdiagnosis may lead to persistent disability until sinus formation and sequestration dictate operative intervention.

4. Early antibiotic therapy may lead to resolution of the infection.

1. Five cases of Salmonella osteomyelitis in infants without red-cell sickling are reported.

2. All these cases occurred in children under eighteen months of age and within a period of five months of time, suggesting a seasonal incidence.

3. Only one strain of Salmonella was isolated–Salmonella typhimurium.

4. There was complete healing in four of the cases.

5. In one case there was destruction and complete absorption ofthe upper humeral epiphysis.

1. A series of 328 cases of acute haematogenous osteomyelitis in children is analysed.

2. In the first group ofseventy-seven cases from 1944 to 1950 penicillin gave excellent results.

3. After 1950 the disease took on new characteristics in terms of frequency, severity and age incidence, with the appearance of a staphylococcus resistant to penicillin: 251 cases are recorded from 1951 to 1960.

4. The importance of the early assessment ofthe disease into degrees of severity is emphasised as the surgeon's guide in his form of management.

5. The value of operative decompression is discussed.

6. The frequent and dire consequences of hip joint involvement are analysed and draillage of the hip joint is described.