In case when a cavity is detected in the place of a diagnosed osteomyelitis and when the location of the lesion is in the metaphyseal area, a revision can be done by an endoscopic method, using a standard arthroscopic device. This method was called as “medulloscopy”. In our paper we would like to introduce our first experiences with this method.

We performed six surgeries of a chronic tibia osteomyelitis by an endoscopic method (medulloscopy) between January 2012 and December 2014. In four surgeries we treated a proximal metaphyseal tibia osteomyelitis and in two surgeries a distal tibial metaphysis. The group of patients consisted of one female and five male of an average age 50.8 years, with ages ranging between 36 and 82 years.

Mean duration of local difficulties preoperatively caused by chronic osteomyelitis was 96 months (from 3 to 304 months). We followed the patients averaged 17.5 months (4–24 months). By April 2015 all six patients (100%) were without need of reoperation for relapse of chronic osteomyelitis.

In our opinion the medulloscopy belongs to the spectrum of procedures for the revision of the long bones metaphyses, especially the tibia. The balance sheet for the use of this surgical method must be reasonable in relation to the type of surgery, the limits of arthroscopic instruments and experience of the surgeon.

Osteomyelitis caused by resistant bacterial strains can be dealt with antimicrobial agents which have a different mode of action compared to antibiotics. A very promising appears to be antimicrobial peptides (AMPs). We found and verified in vitro experiments that one of the most effective and least toxic antimicrobial peptides are contained in the wild bee venom.

The aim of this study was to verify the efficacy of topically applied, synthetically prepared antimicrobial peptide (Hal 2/27) with carrier, originally isolated from the venom of the wild bee in experiments on laboratory rats.

It was used 18 rats, which were indicated osteomyelitis of the left femurs. After a week of six rats were injected calcium phosphate carrier with AMP Hal 2/27, six rats received only a carrier without AMP and six other rats remained without further intervention. After a week, rats were sacrificed and X-ray was performed in all rats limbs.

Rats who received carrier with AMP Hal 2/27 had less X-ray evidence of osteomyelitis of femurs compared to rats after administration of the carrier without AMP.

Topical application of a new synthetic antimicrobial peptides isolated from wild bee venom (Hal 2/27) using local carriers seems to be a promising way to treat and prevent infectious complications in orthopedics and traumatology.

Internal grant of University Hospital Motol, Advanced Therapies, NO: 9777 and Internal grant of University Hospital Motol, NO 6010