Principles of the therapy of bone infections in adult extremities : Are there any new developments?

Abstract

Septic diseases of the bone and immediately surrounding soft tissues can be differentiated into osteitis or osteomyelitis. Both are a most serious diagnosis in modern traumatology and orthopaedic surgery. The basis for treatment is a highly specific, problem-adapted therapy with a defined strategy, the paramount goal being to preserve the stable weightbearing bones, maintain a good mechanical axis with correctly working muscles and joints, and avoid permanent disability. “State-of-the-art” therapy of osteitis and osteomyelitis has two priorities: (a) Eradication of the infection; (b) Reconstruction of bone and soft tissue. Surgical treatment with resection of the affected bone segments and soft tissue, followed by reconstructive methods continues to be the main basic therapy, and is supported by local and systemic antibiotics and adjuvant methods such as hyperbaric oxygen. This article provides an overview of the diagnostic features and different surgical procedures as well as the current literature in order to reach the above named goals.