The ultimate diagnostic proof of chronic osteomyelitis (COM) is the association of a compatible clinical presentation with an unequivocal positive deep bone sample culture. Intraoperative deep bone samples cultures has been widely considered the gold standard in this setting but the preoperative identification of the infecting microorganism through a bone biopsy is of paramount importance in the diagnostic and treatment protocol of any COM. Unfortunately, preoperative bone biopsies have proven to have a broad range of sensitivity values and the most useful biopsy technique remains unknown. The correlation of the preoperative and intraoperative microbiological results is a matter of concern. The purpose of this study was to assess the diagnostic accuracy of a percutaneous bone biopsy (PBB) and an open bone biopsy (OBB) in isolating the infecting organism in cases of lower extremity chronic osteomyelitis. A retrospective study was done involving 29 patients suspected of COM and where either a PBB or OBB was performed during the preoperative diagnostic workup. Culture results from PBB and OBB were compared with intraoperative tissue cultures at the time of surgery. Epidemiologic data was recorded, Cierny-Mader type, number of samples, susceptibility profile, and technique-related complications. Only tibia and femur osteomyelitis were considered.Aim
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