What is it?

High trauma injuries, gun shot wounds, blast injuries of war and animal bites often result in severe soft tissues damage. The main concern regarding open fractures is that they may lead to contamination and, possibly, subsiquent chronic osteomyelitis. Osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation. It may present with periods of quiescence of variable duration after injury. Its management remains challenging, needing multidisciplinary approach, involving radiologists, infectivologists, orthopaedic surgeons and plastic surgeons. Combined antimicrobial and surgical treatment have to be considered in all cases, including appropriate dead space management and subsequent reconstruction. Every treatment must be tailored to each patient according to severity and duration of symptoms, as well as to the clinical and radiological response to treatment. It is important to bear in mind that relapse can occur, even following an apparently successful treatment.

Which are the symptoms?

Osteomyelitis is an infection of a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissues. In other cases an open fracture or surgery may expose the bone to the infection. Sometimes osteomyelitis causes no signs and symptoms or the signs and symptoms are hard to distinguish from other problems.

  • swelling
  • fever
  • numbness
  • achiness
  • warmth and redness over the area of the infection
  • fatigue
  • sepsis
  • leakage through the wound
  • lost range of motion

How is it diagnosed?

Laboratory investigations can be helpful, but generally lack specificity for osteomyelitis. Microbial cultures are essential in the diagnosis and treatment of osteomyelitis. The gold standard for the diagnosis of osteomyelitis is the presence of positive bone cultures and histopathologic examination of the bone. Simple radiography, magnetic resonance imaging (MRI) and bone scintigraphy with labeled white cells combined with CT scan are the most useful modalities.

Suggested exams

How is it treated?

The ideal target of treatment of chronic osteomyelitis is complete eradication of infection while preserving surrounding soft-tissues, healing of bone segment, and preservation of limb length and function.                                 

  • Antibiotic therapy
    Effective treatment of chronic osteomyelitis requires prolonged antimicrobial therapy, properly designed after identification of the infective organisms and their susceptibility.                                                                              
  • Surgical debridement
    Essential for successful treatment of chronic osteomyelitis is aggressive surgical debridement of infected and devitalized tissue, removal of fixation or prosthetic material, with wide excision with clear vascular margins.
  • Soft-tissue reconstructions
    Highly vascularized soft-tissue coverage in a single or two- stage procedure with microvascular free-muscle transfer or local flaps transposition is mandatory to obtain an effective treatment.

Suggested procedures

Where do we treat it?

Within the San Donato Group, you can find Osteomyelitis specialists at these departments:

Are you interested in receiving the treatment?

Contact us and we will take care of you.