Chronic
osteomyelitis
Once osteomyelitis is established it is almost impossible to eradicate.
The intraosseus blood vessels thrombose and the bone infarcts. Pus lifts the
periosteum. If the process continues the pus ruptures through the periosteum,
tracks into the soft tissues and may even discharge through the skin remote from
the initial site of infection. The bone may die and form a sequestrum. The new
bone formed by the periosteum which has been lifted is known as an involucrum.
Once there is dead bone the infecting organisms have a permanent site where they
can survive beyond the reach of the body’s immune system or of antibiotics.
Any time that the patient’s resistance to infection is reduced, the infection
can break out again and produce a septicaemia. Brodie’s abscess is a chronic
abscess walled off in sclerotic bone. This can remain dormant for many years.
Treatment
of chronic osteomyelitis
All dead tissue needs to be removed. If there is a fracture, this will
need to be stabilised. If there was previous fixation which
Chronic
osteomyelitis
• Excise all dead tissue
• Take deep cultures
• Give appropriate antibiotics
• Reconstruct limb