Infections of bone, or osteomyelitis, can be classified into acute, subacute and chronic dependent on the infecting organism. The type of infection will also be dependent on the length of infection, the resistance of the patient and the infecting organism. It will also be influenced by previous antibiotic treatment.
Osteomyelitis may also be caused by a blood stream infection. It can also be due to an infection introduced at an operation to stabilise a fracture or to replace a joint. The most common cause of bone infection, however, is due to infection introduced in an open or compound fractures.
Pyogenic organisms may also infect a joint from the bloodstream or by a direct infection. Infection of a joint may also be spread from an adjoining osteomyelitis. Conversely, an infected joint may cause an osteomyelitis in the adjacent bones.
Treatment of osteomyelitis and pyogenic arthritis can be divided into conservative with immobilisation to rest the bone or joint, medical treatment only with intravenous or direct antibiotic instillation, and operative treatment.
Operative treatment will be dependent on whether the infection is acute or chronic, the site of infection and whether the bone involved is essential to the stability of the limb. It will also be dependent on associated complications such as severe toxemia in acute infections, associated sequestra or pressure on vessels or nerves. Illustrative cases will be shown which will illustrate the correct management of bone infections.
In tuberculosis of bone and joint, and in certain other low grade infections such as brucellosis, the infection usually starts as a low grade sub-acute blood stream spread to a joint, or to the disc of the spine. In untreated cases it will then secondarily spread to the adjacent bone. The clinical features, investigations, treatment, and associated complications will be illustrated with examples of specific patients.
The management of patients with bone and joint infections will be divided into infections of the upper limb, the spine and lower limbs in the following 93 illustrative cases.