Acute osteomyelitis

Acute osteomyelitis should be treated before a definitive diagnosis. Treatment includes:

❑ administration of large doses of I.V. antibiotics after blood cultures are obtained

❑ early surgical drainage to relieve pressure buildup and sequestrum formation

❑ immobilization of the affected bone by plaster cast, traction, or bed rest

❑ supportive measures, such as administration of an analgesic and I.V. fluids.

If an abscess forms, treatment includes incision and drainage, followed by a culture of the drainage.
Antibiotic therapy to control infection may include administration of a systemic antibiotic; intracavitary
instillation of an antibiotic through closed-system continuous irrigation with low intermittent suction;
limited irrigation with a closed drainage system with suction; or local application of packed, wet, antibiotic-
soaked dressings.

Chronic osteomyelitis

With chronic osteomyelitis, surgery is usually required to remove dead bone (sequestrectomy) and to
promote drainage (saucerization). The prognosis is poor even after surgery. Patients are usually in great
pain and require prolonged hospitalization. Resistant chronic osteomyelitis in an arm or leg may necessitate
amputation.

Some facilities also use hyperbaric oxygen to increase the activity of naturally occurring leukocytes.

Free tissue transfers and local muscle flaps are also used to fill in dead space and increase blood supply.

The most common treatments for osteomyelitis are antibiotics and surgery to remove portions of bone that
are infected or dead.

Medications
A bone biopsy will reveal what type of germ is causing your infection, so your doctor can choose an
antibiotic that works particularly well for that type of infection. The antibiotics are usually administered
through a vein in your arm for at least six weeks. Side effects may include nausea, vomiting and diarrhea.

Surgery
Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following
procedures:

• Drain the infected area. Opening up the area around your infected bone allows your surgeon to
drain any pus or fluid that has accumulated in response to the infection.
• Remove diseased bone and tissue. In a procedure called debridement, the surgeon removes as
much of the diseased bone as possible, taking a small margin of healthy bone to ensure that all the
infected areas have been removed. Surrounding tissue that shows signs of infection also may be
removed.
• Restore blood flow to the bone. Your surgeon may fill any empty space left by the debridement
procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your
body. Sometimes temporary fillers are placed in the pocket until you're healthy enough to undergo
a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new
bone.
• Remove any foreign objects.