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Oxford Textbook of Rheumatology (4 ed.)

Jeremy Field

and Neil Upadhyay


The word osteomyelitis is derived from Greek words osteon denoting bone, myelo meaning marrow, and itis, inflammation. Infection may involve one part of bone or extend through marrow, cortex, and periosteum, and even into surrounding tissues. Osteomyelitis results from a microorganism that leads to necrosis and bone destruction. The aetiopathogenesis of osteomyelitis in the United Kingdom is changing. Ageing populations, orthopaedic surgery, peripheral vascular disease, decubitus ulcers, and immunocompromised patients (from either disease or immune-modulating agents) all affect the epidemiology and provide new challenges. Despite new imaging techniques, diagnosis is often delayed, thus heightened index of suspicion for the condition particularly in high-risk patient groups is required. Identification of the causative organisms is essential for diagnosis, treatment, and prognosis of osteomyelitis. Management of osteomyelitis can prove difficult and result in significant morbidity and disability. Early recognition and commencement of appropriate treatment is vital. A combined antimicrobial and surgical approach should be considered in all cases; however, antimicrobial therapy alone may be appropriate in treatment of acute osteomyelitis in certain situations. Chronic osteomyelitis necessitates a multidisciplinary approach with specialized teams. Surgical strategies such as meticulous debridement and dead-space management coupled with cancellous bone grafts and circular frame cancellous-distraction osteogenesis have enabled eradication of infection and limb preservation in previously unsalvageable situations. That said, there remains a subgroup of patients who should be recognized, with chronic infection and concomitant systemic disease, in whom surgical intervention will not alter the prognosis.

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