Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 4 , ISSUE 2 ( October, 2009 ) > List of Articles

Original Article

Principles of the therapy of bone infections in adult extremities

Andreas Heinrich Tiemann, Gunther O. Hofmann

Keywords : Osteitis, Osteomyelitis, Surgical therapy

Citation Information : Tiemann AH, Hofmann GO. Principles of the therapy of bone infections in adult extremities. 2009; 4 (2):57-64.

DOI: 10.1007/s11751-009-0059-y

License: CC BY-NC-SA 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2009; The Author(s).


Abstract

Septic diseases of the bone and immediately surrounding soft tissues can be differentiated into osteitis or osteomyelitis. Both are a most serious diagnosis in modern traumatology and orthopaedic surgery. The basis for treatment is a highly specific, problem-adapted therapy with a defined strategy, the paramount goal being to preserve the stable weightbearing bones, maintain a good mechanical axis with correctly working muscles and joints, and avoid permanent disability. “State-of-the-art” therapy of osteitis and osteomyelitis has two priorities: (a) Eradication of the infection; (b) Reconstruction of bone and soft tissue. Surgical treatment with resection of the affected bone segments and soft tissue, followed by reconstructive methods continues to be the main basic therapy, and is supported by local and systemic antibiotics and adjuvant methods such as hyperbaric oxygen. This article provides an overview of the diagnostic features and different surgical procedures as well as the current literature in order to reach the above named goals.


PDF Share
  1. Simon C, Stille W (1997) Antibiotikatherapie in Klinik und Praxis. 9. Auflage, Schattauer, Stuttgart
  2. Schnettler R, Steinau HU (2004) Septische Knochenchirurgie. Thieme Verlag. ISBN 3-13-116981-8
  3. Hofmann G, Gonschorek O, Hofmann GO, Bühren V (1997) Stabilisierungsverfahren bei Osteomyelitis. Osteosyn Intern 5:226-231
  4. Cierny III G, Mader JT, Penninck JJ (1985) A clinical staging system for adult osteomyelitis. Contemp Orthop 10:17-37. Reprint in: Clinical Orthop and Rel Res (2003), (414):7-24
  5. Hendrich C, Frommelt L, Euler J (2004) Septische Knochen- und Gelenkchirurgie. Springer Verlag. ISBN 3-540-21341-4
  6. Coles CP, Gross M (2000) Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature. Can J Surg 43:256-262
  7. Ostermann PA, Seligson D, Henry SL (1995) Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. J Bone Joint Surg Br 77:93-97
  8. DeLong WG, Born CT, Wei SY, Petrik ME, Ponzio R, Schwab CW (1999) Aggressive treatment of 119 open fracture wounds. J Trauma 46:1049-1054
  9. Kindsfater K, Jonassen EA (1995) Osteomyelitis in grade II and III open tibia fractures with late debridement. J Orthop Trauma 9:121-127
  10. Ehrenberg JP (1996) GAK. Fractuur statisticken. In: Taurolidine in treatment of experimental post-traumatic osteomyelitis. CIPData Koniklijkse Bibliotheken Den Haag
  11. Schwameis E, Abdolvahab F, Wurnig C (1996) Osteomyelitis. Radiologe 36:823-833
  12. ittel KK, Weise K (2003) Komplikationsmanagement in der Traumatologie. Georg Thieme Verlag. ISBN 3-13-129161-3
  13. Mader JT, Cripps MW, Calhoun JH (1999) Imaging of spine and spinal cord. Raven, New York, pp 278-289
  14. Haas DW, Mc Andreaw MP (1996) Bacterial osteomyelitis in adults: envolving considerations in diagnosis and treatment. Am J Med 101:550-561
  15. Schmidt HGK, Kranz HW, Siebert Ch (1997) Die Behhandlung von langstreckigen Infekt-Defekt-Pseudarthrosen mit Segmenttransport im Ringfixateur. Osteosyn Intern 5:212-220
  16. Kälicke T, Kutscha-Lissberg F, Frangen TM, Muhr G, Arens S (2004) Pathophysiologie der posttraumatischen Osteitis. Orthopäde 33:404-411
  17. Tsukayama DT (1999) Pathophysiology of posttraumatic osteomyelitis. Clin Orthop 360:22-34
  18. Simpson AHRW, Deakin M, Latham JM (2001) The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg Br 81:1046-1050
  19. Abe E, Yen K, Okada K (2000) Pyogenic vertebral osteomyelitis presenting as a single spinal compression fracture: a case report and review of the literature. Spinal Cord 38:639-644
  20. Lehovsky J (1999) Pyogenic vertebral osteomyelitis/disc infection. Baillieres Clin Rheumatol 13:59-75
  21. Schauwecker D (1992) The scintigraphic diagnosis of the osteomyelitis. AJR 158:9-18
  22. Even-Saphir E, Martin RH (1994) Degenerative disc disease: a cause for diagnostic dilemma on In-111 WBC studies in suspected osteomyelitis. Clin Nucl Med 19:338-392
  23. Guhlmann A, Storck M, Kotzerke J, Moog F, Sunder-Plassmann L, Reske SN (1997) Chronic osteomyelitis. Detection with FDG PET and correlation with histopathologic findings. Radiology 206:749-754
  24. Robiller FC, Stumpe KD, Kossmann T, Weishaupt D, Bruder E, von Schulthess GK (2000) Chronic osteomyelitis of the femur: value of PET imaging. Eur Radiol 10:855-858
  25. Neugebauer C, Graf R (2004) Gutachterliche Probleme bei der Beurteilung von Osteomyelitiden. Orthopäde 33:603-613
  26. David A, Richter J, Köller M, Muhr G (1997) Therapie der frühen Infektion nach Osteosynthese. Osteosyn Intern 5:232-235
  27. Liener U, Kienzl L (1997) Die Behandlung der posttraumatischen Osteomyelitis. Osteosyn Intern 5:193-198
  28. Kutscha-Lissberg F, Hebler U, Kälicke T, Arens S (2004) Prinzipien chirurgischer Therapiekonzepte der postoperativen und chronischen Osteomyelitis. Orthopäde 33:439-454
  29. Schmidt HGK, Wurm M, Halder D, Grosser V (2002) Verlängerungstechniken und Möglichkeiten des Segmenttransportes im Ringsystem nach Ilizarov. Trauma und Berufskrankh 4:413-426
  30. Alonge TO, Wale A (1999) Intraoperative antibiotic bead maker: point of technique. Afr J Med Sci 28(3-4):193-194
  31. Korkusuz F, Korkusuz P, Gursel I, Hasirici V (2001) In vivo response to biodegradable controlled antibiotic release systems. J Biomed Mater Res 55(2):217-228
  32. Heppert V, Glatzel U, Wentzensen A (2004) Postoperative und bakterielle Osteitis. Orthopäde 33:316-326
  33. Schieker M, Mutschler W (2006) Die Überbrückung von posttraumatischen Knochendefekten. Unfallchirurg 109:715-732
  34. Masquelet AC, Fitoussi F, Begue T, Muller GP (2000) Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet 45(3):346-353
  35. Tiemann AH, Braunschweig R, Hofmann GO (2008) Kontinuitätserhalt oder Segmentresektion: Entscheidungshilfen bei der Sanierung der Osteitis am Schaft langer Röhrenknochen. Trauma und Berufskrankheit. doi:10.1007/s10039-008-1441-6
  36. Ilizarov GA (1992) Transosseous osteosynthesis. Springer, Berlin, pp 137-256
  37. Baumgart R, Hinterwimmer S, Krammer M, Mutschler W (2004) Bone transport system with central cable- fully automatic, continuous distraction osteogenesis for the treatment of large bone defects. Biomed Tech 49:202-207
  38. Weber U (1998) Segmenttransport des Knochens mittels Kabelrollen und fexibelem Draht—eine neue Technik am Ringfixateur. Med Orthop Tech 118:134-140
  39. Canadell J, Forriol F (1997) The external fixator in the treatment of infected pseudarthrosis and bone defect. Osteosyn Intern 5:221-225
  40. UHMS (1999) Hyperbaric oxygen therapy 1999. Committee report. Undersea & Hyperbaric Medical Society, Kensington
  41. Mendel V, Reichert B, Simanowski HJ, Scholz HC (1999) Therapy with hyperbaric oxygen and cefazolin for experimental osteomyelitis due to Staphylococcus aureus in rats. Undersea Hyperbar Med 26:169-174
  42. Park MK, Muhvich KH, Myers RAM, Marzella L (1991) Hypoxia prolongs the aminoglycoside-induced post-antibiotic effect in Pseudomonas aeruginosa. Antimicrob Agents Chemother 35:691-695
  43. Greensmith JE (2004) Hyperbaric oxygen therapy in extremity trauma. J Am Acad Orthop Surg 12(6):376-384
  44. Tiemann AH, Diefenbeck M, Mückley T, Hofmann GO (2008) Hyperbare Sauerstofftherapie in der Osteitisbehandlung—Gibt es Neuigkeiten? Zentralblatt für Chirurgie 133:396-398
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.