About bone infection

The management of infection of bone (osteomyelitis) is challenging. The use of antibiotics has virtually eliminated infection as a major medical problem in the 21st century, but it remains a significant problem in bone due to the poor blood supply in normal bone, and the virtually non-existent blood supply of injured bone, since antibiotics can only penetrate where there is a blood supply. If there is metal in the area, this can act as a reservoir of infection and is a particular problem.

Treatment of bone infection

In the absence of fracture, infection can be treated by removal of infected bone (debridement) followed by reconstruction by plastic surgery if there is sufficient bone remaining. If a whole segment of bone is involved, it may need removal, and new bone creating by the use of the Ilizarov technique.

In the case of infected fractures, the primary treatment often involves removal of any metalwork; the fracture site has to be stabilised by another method until healed, which usually means external fixation methods such as the Ilizarov technique.

In rare cases it may be possible to retain internal fixation if it is being effective, and suppress the infection until fracture union, then remove the implants as soon as viable.

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