A case of salmonella osteomyelitis of the spine complicated by meningitis after needle biopsy is described. The importance of obtaining definitive bacteriological diagnosis in bone infection is emphasised and the changing pattern of salmonella infection discussed

An unusual case of bilateral chronic sclerosing osteomyelitis of the clavicles is reported. A culture of resistant Staphylococcus aureus was obtained. Curettage of the lesions resulted in healing and symptomatic relief. There has been no recurrence on follow-up at one year

Mucormycosis is an opportunistic infection that very occasionally causes osteomyelitis and avascular necrosis of bone. The infection may prove fatal if not diagnosed promptly. If early treatment is instituted the prognosis is good

We prepared a composite of D,L-lactic acid oligomer and dideoxykanamycin B for use as a biodegradable antibiotic delivery system with sustained effect. The composite was implanted in the distal portion of the rabbit femur, and the effective concentration of the antibiotic was measured in the cortex, the cancellous bone, and the bone marrow. In all bone tissues around the implant, the concentration of antibiotic exceeded the minimum inhibitory concentration for the common causative organisms of osteomyelitis for six weeks. Most of the implant material had been absorbed and the bone marrow had been repaired to a nearly normal state within nine weeks of implantation. The implant caused no systemic side effects, and it is likely to prove clinically useful as a drug delivery system for treating chronic osteomyelitis

We reviewed the ultrasound findings in 59 children suspected of having bone infection. Twenty-nine were eventually proved to have acute haematogenous osteomyelitis and 26 of these showed characteristic ultrasound findings. Such changes were rare in 30 patients with other clinically similar conditions. Ultrasound examination was also able to detect the presence of subperiosteal pus and thus indicate the need for surgical treatment

Twenty-nine bone defects caused by chronic osteomyelitis have been treated by radical excision of necrotic bone followed by packing the cavities with cancellous homografts held in position by a fibrin sealant. At follow-up three years after operation all except one had healed, though one case had needed a repeat operation. Good incorporation and remodelling of the grafts was observed even when the osseous bed was severely sclerosed

The efficacy of locally implanted antibiotic-calcium hydroxyapatite ceramic composites was investigated for the treatment of experimentally produced, implant-related osteomyelitis in rats. High concentrations of antibiotics were detected at the site of infection and bacteria were eradicated without removal of the metal implants. Parenteral antibiotics and surgical debridement, alone or in combination with antibiotic-impregnated acrylic bone cement, all failed to eradicate the infections

The outcome of primary management of acute osteomyelitis in 655 children treated in New Zealand between 1947 and 1976 is examined. Failure occurred in 20 per cent of children, in four-fifths of whom it was manifest by one year, and half of whom experienced one recurrence only. Lower failure rates were associated with use of bactericidal antibiotics, certain favourable sites, and age over 16 years. Surgical intervention was associated with significantly higher failure rates. The place of surgical intervention and the optimal duration of antibiotic treatment can only be determined by prospective clinical trials

We treated 37 patients with chronic osteomyelitis of the tibia (25), femur (9), radius (2) and humerus (1) by a two-stage technique, comprising radical debridement of all infected bone and soft tissue with the provision of soft-tissue cover, and delayed autogenous bone grafting when necessary. All patients were reviewed at an average of 49 months (12 to 121). Infection-free bone union was achieved in 34. No patient required amputation. Wide excision of all compromised tissue and the closure of bone within a healthy vascularised soft-tissue envelope are essential if infection is to be eradicated. The combined assessment and management of such patients by an orthopaedic surgeon and a plastic surgeon are advocated

The acute childhood diseases haematogenous staphylococcal osteomyelitis and septic arthritis were studied concurrently using avian models which closely resemble the human diseases. Ultrastructural studies during the initial stages of bone and joint infection showed that adherence of bacteria to cartilage, bacterial proliferation, cartilage destruction and subsequent bacterial spread along the vascular channels within cartilage were common to both disease processes. Histological studies revealed that transphyseal blood vessels were present in the growing chickens and were a likely explanation for the frequency of the concurrence of acute osteomyelitis and adjacent joint infection following intravenous injection of bacteria. Transphyseal vessels provide a direct connection between the growth plate (physis) and epiphyseal cartilage supplying a route for bacteria to spread from an osteomyelitic focus in the metaphysis to the epiphysis and subsequently to the joint lumen

We treated 11 patients with chronic osteomyelitis of the tibia or the foot by local excision and transfer of a peroneal myocutaneous island flap. This flap, pedicled proximally or distally on the peroneal artery and veins, provides viable muscle to fill the dead space in bone and skin to close the defect. Ten patients reviewed more than three years after operation were all free of drainage with no clinical or radiographic evidence of recurrence

A case is reported four years after successful total replacement of the left humerus for chronic osteomyelitis of six years' duration, with an axillary sinus that had persisted despite repeated operations and more distally a pathological fracture that had failed to united after bone grafting. The disability was such that the patient had requested amputation, but he returned to his previous work as a driver six months after the total replacement and there has been no recurrence of infection

In the literature 21 children have been reported with haematogenous osteomyelitis involving only the epiphyses of long bones; in 20 the epiphyses of the knee were involved and the radiographs showed a lytic lesion. Most patients gave a history of pain, limp or refusal to walk for weeks or months without general illness. The erythrocyte sedimentation rate and white cell count were of little diagnostic value, but a bone scan was usually positive. All the patients were cured by antibiotics alone or in combination with curettage

We report two cases of Serratia marcescens infection at the sites of spinal fractures and emphasise the fact that neurological deterioration soon after spinal fracture may be due to acute vertebral osteomyelitis

The management of twenty-one children with a defect of the tibial shaft due to acute haematogenous osteomyelitis is described. Half the defects were due to removal of the sequestrum before the involucrum had formed. Only four patients, all under ten years of age, had spontaneous regeneration of the shaft. Eleven children had a posterior tibiofibular graft and six had a transfer of the ipsilateral fibular diaphysis. The results of operation were superior to those of spontaneous regeneration. All the grafts united and the children returned home to lead normal lives. Shortening was only a problem when growth plates or adjacent joints had been damaged. We now leave the sequestrum for up to one year after the onset of infection. If the involucrum fails to form we reconstruct the tibia as soon as possible after sequestrectomy

Infected nonunion of a long bone continues to present difficulties in management. In addition to treating the infection, it is necessary to establish bony stability, encourage fracture union and reconstruct the soft-tissue envelope.

We present a series of 67 infected nonunions of a long bone in 66 patients treated in a multidisciplinary unit. The operative treatment of patients suitable for limb salvage was performed as a single procedure. Antibiotic regimes were determined by the results of microbiological culture.

At a mean follow-up of 52 months (22 to 97), 59 patients (88%) had an infection-free united fracture in a functioning limb. Seven others required amputation (three as primary treatment, three after late failure of limb salvage and one for recalcitrant pain after union).

The initial operation achieved union in 54 (84%) of the salvaged limbs at a mean of nine months (three to 26), with recurrence of infection in 9%. Further surgery in those limbs that remained ununited increased the union rate to 62 (97%) of the 64 limbs treated by limb salvage at final follow-up. The use of internal fixation was associated with a higher risk of recurrent infection than external fixation.

Cite this article: Bone Joint J 2015; 97-B:814–17.

We report a case of systemic Penicillium marneffei infection in a Chinese woman who presented with multiple osteolytic lesions and radiographic changes similar to those seen in other fungal osteomyelitides. This infection is often misdiagnosed as tuberculosis and has a high mortality rate. The correct diagnosis is important since early antifungal therapy is life-saving.