A history of osteomyelitis from the

Journal of Bone and Joint Surgery

 History
Osteomyelitis is infection of the bone with
medula
On the years 1844-1929 Ogston had identied
and named (staphylococci) a bacteri inside
osteomyelitis
He examined pus, carefully removed with
antiseptic precautions, from a series of 82
abscesses. There were 13 from typical cold
abscesses in which he found no organisms. In 65,
from acute abscesses of a few days, there were
micrococci
 in 1940 by Chain et al the management of acute
osteomyelitis was based on the principles of the
American surgeon.
Dressings and plasters were changed as
infrequently as possible in an effort to reduce
secondary infection
Pain and fever provided the main indication
for inspection of the wound
 Between 1936 and 1940, there were 69
patients with 23 deaths, giving a mortality of
33%, but between 1941 and 1945, there were
70 patients, with only seven deaths, a
mortality of 10%. In the series described in the
paper, there were 30 patients of the
septicaemic type treated by penicillin. Of
these, 28 (93%) were well and their
radiographs showed no evidence of bone
disease
 In the adult, acute osteomyelitis of the long
bones is rare. The cortex is absorbed instead
of sequestrating
Surgical treatment included incision of soft-
tissue abscesses, immobilisation, drilling and
guttering, and even amputation
Specic antibiotic treatment started as soon
as possible in adequate doses formed the
basis of successful treatment.
 In 1962, Gilmour analysed a series of 328 cases.
In the rst group of 27, between 1944 and 1950,
penicillin gave excellent results
After 1950, the disease took on new
characteristics in relation to frequency, severity
and age incidence, with the appearance of a
penicillin-resistant Staphyloccocus
 Primary subacute pyogenic osteomyelitis

In 1965, Harris and Kirkaldy-Willis described

primary subacute pyogenic osteomyelitis. The
main clinical features were the long history
with often weeks or months before diagnosis.
Curettage and local antibiotics were usually
sufcient to treat a localised bone abscess
 Surgery was only indicated if pus was clinically
detected.
 Chronic osteomyelitis
With the help of antibiotics, chronic
osteomyelitis is potentially curable,but surgery
is needed to improve the blood supply to the
affected bone
The removal of sequestra and scar tissue is
usually achieved easily, but elimination of the
dead space is the more difcult procedure.
A free skin or muscle ap may be technically
impossible in some situations
 For infection of long bones treated by internal
xation,
This involves debridement, intramedullary
reaming and insertion of tubes with double
lumina in the marrow cavity
 .The end-point of treatment is reached when
the irrigation uid produces three consecutive
clear cultures and obliteration of the volume
of the cavity
Success was achieved in 17 patients in a
series where osteomyelitis had been present
for a mean of 12.5 years
 All patients had a course of antibiotics
intravenously for six weeks, followed by oral
administration for a further six weeks. No
patient in group 1 had a recurrence. In
patients treated by marginal resection, eight
of the 29 (28%) had a recurrence. All patients
who had a debulking had a recurrence within
one year of surgery. Thorough excision is
clearly benecial
 Rarities
Bone infection can be late, silent and often
unexpected. It is usually symmetrical and almost
always multiple. It affects the hands, legs, and
feet. It is destructive, unpreventable and
untreatable. It ends with deformity but not loss of
life. It is the only known example of a virus
infection of bone, and fortunately the disease has
now been eradicated.
 Summary
The reports in the Journal show how acute
haematogeneous osteomyelitis can readily and
successfully be managed in most parts of the
Western world. With the improvement in the
general standard of living, hygiene and nutrition,
the incidence of acute haematogenous
osteomyelitis has declined, in contrast to
developing countries where it remains a
dangerous hazard. The treatment of chronic
osteomyelitis remains difcult everywhere, but
there are clear principles of treatment.