Advances in the treatment of chronic osteomyelitis

Chronic osteomyelitis presents complex diagnostic and therapeutic problems. It can be a prolonged illness having a profound effect on the health of the sufferer. Like many chronic illnesses economic costs for healthcare providers is high. Chronic osteomyelitis is perhaps more common than thought, being the major complication in the surgical management of fractures in multiply injured patients. In elective reconstructive surgery, it is the most dreaded complication of total joint replacement and other reconstructive procedures in the musculoskeletal system. Recent advances in our understanding of the physiology of bone healing, together with the availability of hybrid ring-thin wire fixation frames, have allowed resection of infected bone in any required amount, followed by the implementation of distraction osteogenesis after a rest period of 72 h. Bone gaps of up to 6 cm are managed by acute shortening followed by intermittent distraction in 6 hourly 0.25 mm increments. For longer defects, bone segment transport is used. The former method is more efficient. Thus, a reliable avenue for surgical reconstruction in the treatment of chronic osteomyelitis has become available, which couples radical local resection of the infected focus with biological reconstitution of the surgically created bone defect.