Advances in clinical diagnosis and treatment of chronic osteomyelitis in adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Jinglong ,  YANG Fuchun

Department of Trauma and Hand Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China;

Corresponding author：

YANG Fuchun, Email: yangfuch89@163.com

Keywords：

Adult; chronic osteomyelitis; diagnosis; treatment

DOI：

10.7507/1002-1892.201909032

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To review the progress of clinical diagnosis and treatment of chronic osteomyelitis in adults.Methods The literature related to chronic osteomyelitis in recent years was extensively reviewed, and the clinical diagnosis and treatment methods were summarized.Results Clinical characteristics and laboratory examination can help to diagnose chronic osteomyelitis in adults. Pathogenic identification is the basis for choosing antibiotics. Diagnostic imaging is specific. The treatment includes systemic treatment and local treatment, and the local treatment is the key to radical cure.Conclusion The diagnosis of chronic osteomyelitis in adults should be made as early as possible. According to the anatomical and physiological classification of the patients, the appropriate treatment plan should be made.

Citation： MA Jinglong, YANG Fuchun. Advances in clinical diagnosis and treatment of chronic osteomyelitis in adults. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 651-655. doi: 10.7507/1002-1892.201909032 Copy

1.	Hogan A, Heppert VG, Suda AJ. Osteomyelitis. Arch Orthop Trauma Surg, 2013, 133(9): 1183-1196.
2.	Wang X, Yu S, Sun D, et al. Current data on extremities chronic osteomyelitis in southwest China: epidemiology, microbiology and therapeutic consequences. Sci Rep, 2017, 7(1): 16251.
3.	Taki H, Krkovic M, Moore E, et al. Chronic long bone osteomyelitis: diagnosis, management and current trends. Br J Hosp Med (Lond), 2016, 77(10): C161-C164.
4.	Rao N, Ziran BH, Lipsky BA. Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg, 2011, 127(Suppl 1): 177S-187S.
5.	Tschudin-Sutter S, Frei R, Dangel M, et al. Validation of a treatment algorithm for orthopaedic implant-related infections with device-retention-results from a prospective observational cohort study. Clin Microbiol Infect, 2016, 22(5): 457. e1-e9.
6.	Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg, 2005, 13(6): 417-427.
7.	Schattner A, Dubin I, Gelber M. A new diagnostic clue to osteomyelitis in chronic leg ulcers. Am J Med, 2016, 129(5): 538-539.
8.	Jiang N, Qin CH, Hou YL, et al. Serum TNF-α, erythrocyte sedimentation rate and IL-6 are more valuable biomarkers for assisted diagnosis of extremity chronic osteomyelitis. Biomark Med, 2017, 11(8): 597-605.
9.	Lew DP, Waldvogel FA. Osteomyelitis. Lancet, 2004, 364(9431): 369-379.
10.	Vemu L, Sudhaharan S, Mamidi N, et al. Need for appropriate specimen for microbiology diagnosis of chronic osteomyelitis. J Lab Physicians, 2018, 10(1): 21-25.
11.	Shemesh S, Kosashvili Y, Groshar D, et al. The value of 18-FDG PET/CT in the diagnosis and management of implant-related infections of the tibia: a case series. Injury, 2015, 46(7): 1377-1382.
12.	Xiao L, Li T, Ding M, et al. Detecting chronic post-traumatic osteomyelitis of mouse tibia via an IL-13Rα2 targeted metallofullerene magnetic resonance imaging probe. Bioconjug Chem, 2017, 28(2): 649-658.
13.	Pickett JE, Thompson JM, Sadowska A, et al. Molecularly specific detection of bacterial lipoteichoic acid for diagnosis of prosthetic joint infection of the bone. Bone Res, 2018, 6: 13.
14.	Khalid M, Bora T, Ghaithi AA, et al. Raman spectroscopy detects changes in bone mineral quality and collagen cross-linkage in Staphylococcus infected human bone. Sci Rep, 2018, 8(1): 9417.
15.	Spellberg B, Lipsky BA. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis, 2012, 54(3): 393-407.
16.	Inanmaz ME, Uslu M, Isik C, et al. Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant-related chronic osteomyelitis: experimental study in a rat model. J Orthop Res, 2014, 32(6): 752-756.
17.	Anagnostakos K, Wilmes P, Schmitt E, et al. Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo. Acta Orthop, 2009, 80(2): 193-197.
18.	Barrett RJ, Sandquist L, Richards BF, et al. Antibiotic-impregnated polymethylmethacrylate as an anterior biomechanical device for the treatment of cervical discitis and vertebral osteomyelitis: technical report of two cases. Turk Neurosurg, 2014, 24(4): 613-617.
19.	Fantoni M, Taccari F, Giovannenze F. Systemic antibiotic treatment of chronic osteomyelitis in adults. Eur Rev Med Pharmacol Sci, 2019, 23(2 Suppl): 258-270.
20.	Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg (Am), 2004, 86(10): 2305-2318.
21.	Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician, 2001, 63(12): 2413-2420.
22.	Fosco M, Gualdrini G, Ben Ayad R. The role of active immunization therapy as preoperative treatment for chronic osteomyelitis. Musculoskelet Surg, 2014, 98(1): 45-52.
23.	Sakata J, Sasaki S, Handa K, et al. A retrospective, longitudinal study to evaluate healing lower extremity wounds in patients with diabetes mellitus and ischemia using standard protocols of care and platelet-rich plasma gel in a Japanese wound care program. Ostomy Wound Manage, 2012, 58(4): 36-49.
24.	Attinger CE, Bulan EJ. Débridement. The key initial first step in wound healing. Foot Ankle Clin, 2001, 6(4): 627-660.
25.	王江宁, 高磊. 糖尿病足慢性创面治疗的新进展. 中国修复重建外科杂志, 2018, 32(7): 832-837.
26.	Vicenti G, Bizzoca D, Cotugno D, et al. The use of a gentamicin-coated titanium nail, combined with RIA system, in the management of non-unions of open tibial fractures: A single centre prospective study. Injury, 2019. [Epub ahead of print].
27.	Kinik H, Karaduman M. Cierny-Mader Type Ⅲ chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics. Int Orthop, 2008, 32(4): 551-558.
28.	Tetsworth K, Cierny G 3rd. Osteomyelitis debridement techniques. Clin Orthop Relat Res, 1999, (360): 87-96.
29.	Luo S, Jiang T, Yang Y, et al. Combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded PMMA in the treatment of chronic osteomyelitis. BMC Musculoskelet Disord, 2016, 17(1): 502.
30.	McNally MA, Ferguson JY, Lau AC, et al. Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: a prospective series of 100 cases. Bone Joint J, 2016, 98-B(9): 1289-1296.
31.	Zhou J, Zhou XG, Wang JW, et al. Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold. Bone Joint Res, 2018, 7(1): 46-57.
32.	Drago L, Vassena C, Fenu S, et al. In vitro antibiofilm activity of bioactive glass S53P4. Future Microbiol, 2014, 9(5): 593-601.
33.	Malat TA, Glombitza M, Dahmen J, et al. The use of bioactive glass S53P4 as bone graft substitute in the treatment of chronic osteomyelitis and infected non-unions-a retrospective study of 50 patients. Z Orthop Unfall, 2018, 156(2): 152-159.
34.	Wang Y, Jiang H, Deng Z, et al. Comparison of monolateral external fixation and internal fixation for skeletal stabilisation in the management of small tibial bone defects following successful treatment of chronic osteomyelitis. Biomed Res Int, 2017, 2017: 6250635.
35.	Chou PH, Lin HH, Su YP, et al. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov’s technique followed by the use of intramedullary locked nail. J Chin Med Assoc, 2017, 80(6): 376-382.
36.	Zhang S, Wang H, Zhao J, et al. Treatment of post-traumatic chronic osteomyelitis of lower limbs by bone transport technique using mono-lateral external fixator: Follow-up study of 18 cases. J Orthop Sci, 2016, 21(4): 493-499.
37.	陈勋, 张文韬, 喻姿瑞, 等. 单边外固定支架联合钢板内固定行骨搬运术治疗胫骨感染性骨不连. 中国修复重建外科杂志, 2019, 33(3): 328-331.
38.	Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg, 2009, 123(1): 230-235.
39.	Hong JPJ, Goh TLH, Choi DH, et al. The efficacy of perforator flaps in the treatment of chronic osteomyelitis. Plast Reconstr Surg, 2017, 140(1): 179-188.
40.	Cierny G 3rd, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res, 2003, (414): 7-24.
41.	Marais LC, Ferreira N, Aldous C, et al. A modified staging system for chronic osteomyelitis. J Orthop, 2015, 12(4): 184-192.

1. Hogan A, Heppert VG, Suda AJ. Osteomyelitis. Arch Orthop Trauma Surg, 2013, 133(9): 1183-1196.
2. Wang X, Yu S, Sun D, et al. Current data on extremities chronic osteomyelitis in southwest China: epidemiology, microbiology and therapeutic consequences. Sci Rep, 2017, 7(1): 16251.
3. Taki H, Krkovic M, Moore E, et al. Chronic long bone osteomyelitis: diagnosis, management and current trends. Br J Hosp Med (Lond), 2016, 77(10): C161-C164.
4. Rao N, Ziran BH, Lipsky BA. Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg, 2011, 127(Suppl 1): 177S-187S.
5. Tschudin-Sutter S, Frei R, Dangel M, et al. Validation of a treatment algorithm for orthopaedic implant-related infections with device-retention-results from a prospective observational cohort study. Clin Microbiol Infect, 2016, 22(5): 457. e1-e9.
6. Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg, 2005, 13(6): 417-427.
7. Schattner A, Dubin I, Gelber M. A new diagnostic clue to osteomyelitis in chronic leg ulcers. Am J Med, 2016, 129(5): 538-539.
8. Jiang N, Qin CH, Hou YL, et al. Serum TNF-α, erythrocyte sedimentation rate and IL-6 are more valuable biomarkers for assisted diagnosis of extremity chronic osteomyelitis. Biomark Med, 2017, 11(8): 597-605.
9. Lew DP, Waldvogel FA. Osteomyelitis. Lancet, 2004, 364(9431): 369-379.
10. Vemu L, Sudhaharan S, Mamidi N, et al. Need for appropriate specimen for microbiology diagnosis of chronic osteomyelitis. J Lab Physicians, 2018, 10(1): 21-25.
11. Shemesh S, Kosashvili Y, Groshar D, et al. The value of 18-FDG PET/CT in the diagnosis and management of implant-related infections of the tibia: a case series. Injury, 2015, 46(7): 1377-1382.
12. Xiao L, Li T, Ding M, et al. Detecting chronic post-traumatic osteomyelitis of mouse tibia via an IL-13Rα2 targeted metallofullerene magnetic resonance imaging probe. Bioconjug Chem, 2017, 28(2): 649-658.
13. Pickett JE, Thompson JM, Sadowska A, et al. Molecularly specific detection of bacterial lipoteichoic acid for diagnosis of prosthetic joint infection of the bone. Bone Res, 2018, 6: 13.
14. Khalid M, Bora T, Ghaithi AA, et al. Raman spectroscopy detects changes in bone mineral quality and collagen cross-linkage in Staphylococcus infected human bone. Sci Rep, 2018, 8(1): 9417.
15. Spellberg B, Lipsky BA. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis, 2012, 54(3): 393-407.
16. Inanmaz ME, Uslu M, Isik C, et al. Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant-related chronic osteomyelitis: experimental study in a rat model. J Orthop Res, 2014, 32(6): 752-756.
17. Anagnostakos K, Wilmes P, Schmitt E, et al. Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo. Acta Orthop, 2009, 80(2): 193-197.
18. Barrett RJ, Sandquist L, Richards BF, et al. Antibiotic-impregnated polymethylmethacrylate as an anterior biomechanical device for the treatment of cervical discitis and vertebral osteomyelitis: technical report of two cases. Turk Neurosurg, 2014, 24(4): 613-617.
19. Fantoni M, Taccari F, Giovannenze F. Systemic antibiotic treatment of chronic osteomyelitis in adults. Eur Rev Med Pharmacol Sci, 2019, 23(2 Suppl): 258-270.
20. Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg (Am), 2004, 86(10): 2305-2318.
21. Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician, 2001, 63(12): 2413-2420.
22. Fosco M, Gualdrini G, Ben Ayad R. The role of active immunization therapy as preoperative treatment for chronic osteomyelitis. Musculoskelet Surg, 2014, 98(1): 45-52.
23. Sakata J, Sasaki S, Handa K, et al. A retrospective, longitudinal study to evaluate healing lower extremity wounds in patients with diabetes mellitus and ischemia using standard protocols of care and platelet-rich plasma gel in a Japanese wound care program. Ostomy Wound Manage, 2012, 58(4): 36-49.
24. Attinger CE, Bulan EJ. Débridement. The key initial first step in wound healing. Foot Ankle Clin, 2001, 6(4): 627-660.
25. 王江宁, 高磊. 糖尿病足慢性创面治疗的新进展. 中国修复重建外科杂志, 2018, 32(7): 832-837.
26. Vicenti G, Bizzoca D, Cotugno D, et al. The use of a gentamicin-coated titanium nail, combined with RIA system, in the management of non-unions of open tibial fractures: A single centre prospective study. Injury, 2019. [Epub ahead of print].
27. Kinik H, Karaduman M. Cierny-Mader Type Ⅲ chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics. Int Orthop, 2008, 32(4): 551-558.
28. Tetsworth K, Cierny G 3rd. Osteomyelitis debridement techniques. Clin Orthop Relat Res, 1999, (360): 87-96.
29. Luo S, Jiang T, Yang Y, et al. Combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded PMMA in the treatment of chronic osteomyelitis. BMC Musculoskelet Disord, 2016, 17(1): 502.
30. McNally MA, Ferguson JY, Lau AC, et al. Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: a prospective series of 100 cases. Bone Joint J, 2016, 98-B(9): 1289-1296.
31. Zhou J, Zhou XG, Wang JW, et al. Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold. Bone Joint Res, 2018, 7(1): 46-57.
32. Drago L, Vassena C, Fenu S, et al. In vitro antibiofilm activity of bioactive glass S53P4. Future Microbiol, 2014, 9(5): 593-601.
33. Malat TA, Glombitza M, Dahmen J, et al. The use of bioactive glass S53P4 as bone graft substitute in the treatment of chronic osteomyelitis and infected non-unions-a retrospective study of 50 patients. Z Orthop Unfall, 2018, 156(2): 152-159.
34. Wang Y, Jiang H, Deng Z, et al. Comparison of monolateral external fixation and internal fixation for skeletal stabilisation in the management of small tibial bone defects following successful treatment of chronic osteomyelitis. Biomed Res Int, 2017, 2017: 6250635.
35. Chou PH, Lin HH, Su YP, et al. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov’s technique followed by the use of intramedullary locked nail. J Chin Med Assoc, 2017, 80(6): 376-382.
36. Zhang S, Wang H, Zhao J, et al. Treatment of post-traumatic chronic osteomyelitis of lower limbs by bone transport technique using mono-lateral external fixator: Follow-up study of 18 cases. J Orthop Sci, 2016, 21(4): 493-499.
37. 陈勋, 张文韬, 喻姿瑞, 等. 单边外固定支架联合钢板内固定行骨搬运术治疗胫骨感染性骨不连. 中国修复重建外科杂志, 2019, 33(3): 328-331.
38. Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg, 2009, 123(1): 230-235.
39. Hong JPJ, Goh TLH, Choi DH, et al. The efficacy of perforator flaps in the treatment of chronic osteomyelitis. Plast Reconstr Surg, 2017, 140(1): 179-188.
40. Cierny G 3rd, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res, 2003, (414): 7-24.
41. Marais LC, Ferreira N, Aldous C, et al. A modified staging system for chronic osteomyelitis. J Orthop, 2015, 12(4): 184-192.

Previous Article
Research progress in anterolateral ligament of knee
Next Article
Research progress of clinical therapy for concha-type microtia

Chinese Journal of Reparative and Reconstructive Surgery

Advances in clinical diagnosis and treatment of chronic osteomyelitis in adults

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content