Diagnosis and management of chronic infection

Jonathan Agner Forsberg, Benjamin Kyle Potter, George Cierny, Lawrence Webb

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

High-energy penetrating extremity injuries are often associated with severe open fractures that have varying degrees of soft-tissue contamination and tenuous soft-tissue coverage. The result is a relatively high prevalence of chronic osteomyelitis compared with that in civilian trauma patients. Diagnosing chronic osteomyelitis requires a careful history and thorough physical and radiographic examinations. Cross-sectional imaging can help delineate the extent of bony involvement, and scintigraphy can be used as a diagnostic tool and to gauge response to treatment. Clinical staging also directs surgical management. Adequacy of débridement remains the most important clinical predictor of success; thus, adopting an oncologic approach to complete (ie, wide) excision is important. Reconstruction can be safely performed by a variety of methods; however, proper staging and patient selection remain critical to a successful outcome. Although systemic and depot delivery of antibiotics plays a supporting role in the treatment of chronic osteomyelitis, the ideal dosing regimens, and the duration of treatment, remain controversial.

Original languageEnglish
Pages (from-to)S8-S19
JournalThe Journal of the American Academy of Orthopaedic Surgeons
Volume19
Issue numberSUPPL.1
DOIs
StatePublished - 2011
Externally publishedYes

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