Chronic Pyogenic Osteomyelitis Research Articles

TUBERCULOUS OSTEOMYELITIS

Tuberculous osteomyelitis which does not involve a joint is uncommon and may fail to be diagnosed by an orthopaedic surgeon. We treated 28 lesions of tuberculous osteomyelitis in 25 patients between 1988 and 1995. The duration of symptoms was from two to 39 months, and most of our patients had been treated initially with non-steroidal anti-inflammatory drugs which failed to provide relief. Bone pain which does not promptly respond to analgesic medication is often due to infection or neoplasia. In the early stages, when plain radiographs are normal, MRI or CT may help to localise lesions. On plain radiographs, more advanced lesions may mimic chronic pyogenic osteomyelitis, Brodie’s abscess, tumours or granulomatous lesions. Biopsy is mandatory to confirm the diagnosis, and antituberculous drugs are the mainstay of treatment. When operative findings at biopsy have the features of skeletal tuberculosis curettage of the affected bone may promote earlier healing.

A Staged Papineau Protocol for Chronic Osteomyelitis

A three-stage Papineau protocol for the management of chronic pyogenic osteomyelitis was critically investigated in 13 prospectively treated patients with draining osteomyelitis. Stage I involved removal of nonviable tissue and retained metal. Stage II involved grafting of cancellous iliac bone. In Stage III skin coverage was accomplished. Infection was eradicated in all but one patient, and the osseous defect filled in all patients. Five patients attained skin coverage after split-thickness grafting. In seven patients epithelialization occurred, while one patient underwent a soleus muscle transposition with skin grafting. The prospective protocol could have been improved by prolonged hospitalization with repeated surgical debridements. Rather than demonstrating absolute cure of all kinds of osteomyelitis, the present results reveal factors that help to ensure successful treatment.

Aetiology and control of chronic pyogenic osteomyelitis in Ile-Ife, Nigeria.

Fifty-six patients suffering from chronic osteomyelitis, who attended the University of Ife Teaching Hospital, Ile-Ife, Nigeria, between November 1976 and December 1977 were studied. Poor hygiene, ignorance, sickle cell disease, and minor trauma in the form of cuts, abrasions, insect bites, and thorn-pricks were the main predisposing factors. Open fractures resulting from road accidents, and infection following surgical procedures, contributed to a lesser extent and may well become the main source of chronic bone infection in the near future. Measures are suggested for the control of the disease.

Socio-economic implications of chronic pyogenic osteomyelitis in a developing community.

THE SOCIAL implications, and the magnitude of the economic burden caused by chronic osteomyelitis have been studied from fifty-six patients encountered in the Teaching Hospital of the University of Ife, Ile-Ife, Nigeria, between November 1976 and December 1977. The disease may become a social stigma because of the unpleasant odour of the discharge from the sinuses. Amputation, which is sometimes the last resort in the treatment of this disease, was rejected by patients for whom it was suggested because of its socio-economic and socio-cultural problems. The major sources of financial loss to the patients, and or to the health services included prolonged use of expensive antibiotics, maintenance during the usual long hospitalisation, the cost of surgical operations which often have to be repeated, expenses incurred in arranging for blood donors since free and willing donors are now scarce in this society, and the transport fares to and from the hospital during the repeated visits for the necessarily prolonged period of follow-ups. Besides, there is a waste of valuable manpower time since patients invariably lose time from work, and/or school.

Socio-economic implications of chronic pyogenic osteomyelitis in a developing community

The social implications, and the magnitude of the economic burden caused by chronic osteomyelitis have been studied in relation to 56 patients encountered in the Teaching Hospital of the University of Ife, Ile-Ife, Nigeria, between November 1976 and December 1977. The disease may become a social stigma because of the unpleasant odour of the discharge from the sinuses. Amputation, which is sometimes the last resort in the treatment of this disease, was rejected by patients for whom it was suggested because of its socio-economic and socio-cultural problems. The major sources of financial loss to the patients, and/or to the health services, included prolonged use of expensive antibiotics, maintenance during the usual long hospitalization, the cost of surgical operations which often have to be repeated, expenses incurred in arranging for blood donors — since free and willing donors are now scarce in this society — and the transport fares to and from the hospital during the repeated visits for the necessarily prolonged period of follow-ups. Besides, there is a waste of valuable manpower time since patients invariably lose time from work or school.

Epithelialization of Chronic Osteomyelitic Cavities

IN a previous report, three cases of chronic pyogenic osteomyelitis, with draining sinuses of over 50 years' duration, were described, in which the large intramedullary cavities were found to be partially or nearly completely lined by stratified squamous epithelium (1). This was the result of a downgrowth of the cutaneous epithelium along the draining sinuses. An additional case was reported by Milgram (2). Erdheim (3) showed that in an analogous manner epithelialization of small tuberculous cavities in the calvarium may take place. The following case is recorded because it is another instance of epithelialization of a chronic osteomyelitic cavity, in the manner described above. Whereas in the other four reported cases the osteomyelitis was present for 50 years or more, in this instance it was of 17 years' duration. Case Report P. H. (116,021), white male, aged 65 years, was admitted to the University of Chicago Clinics on Nov. 5, 1934, presenting an oval epithelioma about 2 cm. in diameter on the inner a...