Outcome of management of chronic osteomyelitis at National Orthopaedic Hospital, Enugu

Abstract

Chronic osteomyelitis remains challenging to treat despite advances in antibiotics and new operative techniques. The associated morbidity and difficulty in eradicating the infection has posed a problem for the surgeon. The objective of the study is to evaluate the management of chronic osteomyelitis using the National Orthopaedic Hospital Enugu experience and recommend some modification of the treatment protocol in antibiotic usage. A retrospective study was carried out. Records of fifty patients presenting with chronic osteomyelitis over a ten year period from 1997 to 2006 were analyzed. Patients with incomplete records were excluded. The young active age group was more involved. Majority of the patients presented quite late, more than 6 months from onset of symptoms. Saucerization, curettage and sequestrectomy were the commonest surgical intervention done; as types III and IV [Cierny Mader] chronic osteomyelitis prevailed over the others. The duration of parenteral (intravenous) antibiotics usage was within 72 hours in most of the patients; with oral antibiotic continued for about 48 weeks in most of the patients. Most of the patients had stopped discharging at 12 weeks of follow-up and showed clinical evidence of arrest of the infection. Following adequate surgical debridement in chronic osteomyelitis, short term sensitivity based intravenous antibiotics for 48-72 hours and subsequent oral antibiotics for a variable period of 48 weeks is adequate treatment for chronic osteomyelitis in a non-immuno compromised patient.