Chronic septic osteomyelitis is a continuation of acute septic osteomyelitis and often the systemic symptoms mostly disappear and only manifest when there is poor local drainage. Generally, the symptoms are limited to the local area and are often stubborn and difficult to treat, even for several years or a dozen years. Currently, for most cases, it can be controlled in the short term through properly planned treatment.
I. Etiology.
In the acute phase, most cases can be cured with timely and aggressive treatment, but chronic osteomyelitis still occurs in many patients.
The common causes of the formation of chronic osteomyelitis are as follows.
1. Failure to treat promptly and appropriately in the acute phase, with a large amount of dead bone formation.
2.The presence of foreign bodies and dead cavities such as dead bone or shrapnel.
3, Local extensive scar tissue and sinus tract formation, poor circulation, which is conducive to bacterial growth and cannot be reached by antibacterial drugs.
II. Clinical manifestations
Clinically, when entering the chronic inflammatory phase, there is local swelling, bone thickening, surface roughness, and pressure pain. If there is a sinus tract, the wound does not heal for a long time, and occasionally small pieces of dead bone are discharged. Sometimes the wound heals temporarily, but due to the presence of infected lesions, the spread of inflammation can cause acute attacks, with generalized chills and fever, local redness and swelling, after incision and drainage, or self-piercing, or drug control, the generalized symptoms disappear, local inflammation also gradually subsides, the wound heals, and so on repeatedly. When the whole body health is poor, it is also easy to cause attacks.
Due to repeated inflammation and multiple sinus tracts, there is a greater impact on limb function with muscle atrophy; if pathological fracture occurs, there may be limb shortening or angular deformity; if the onset is close to the joint, there is more joint contracture or stiffness.
Radiographs may show dead bone and a large amount of denser new bone formation, sometimes with cavities, and in case of war injuries, shrapnel may be present. Radiographs of Browder’s abscess show rounded, sparse areas in the long epiphysis with dense bone around the abscess. In Galli’s osteomyelitis, the bone is generally thicker and denser, without obvious dead bone, and the bone marrow cavity disappears.
III. Diagnosis
Based on previous history of acute osteomyelitis or open fracture, local lesion examination and radiographic performance.
IV. Treatment
1.Treatment of chronic septic osteomyelitis
The treatment of chronic septic osteomyelitis generally adopts a combination of surgery and drugs, i.e., improving the general condition, controlling infection and surgical treatment. Treat the original underlying disease and improve the immunity of the body. Drug application is appropriate according to bacterial culture and drug sensitivity test, and effective antibacterial drugs are used. Surgery is usually incision and drainage of pus + VSD negative pressure suction.
2.Treatment of acute osteomyelitis
If there is an acute relapse, it is appropriate to deal with acute osteomyelitis first, strengthen the application of supportive therapy and antibacterial drugs, and depending on the effect of treatment, choose whether to operate and, if necessary, incise and drain so that the acute inflammation can be controlled.
3. Treatment of occasional onset of osteomyelitis without obvious dead bone
No obvious dead bone, symptoms only occasional attacks, and no local abscesses or sinus tracts, it is appropriate to use drug treatment and hot physiotherapy, general rest, generally one or two weeks after the symptoms can disappear, without surgery.
4.Treatment of osteomyelitis with dead bone and foreign body
If there are dead bones, sinus tracts, cavities, foreign bodies, etc., then in addition to drug treatment, surgery should be performed for radical treatment. Surgery should be performed when the general and local conditions improve, the dead bone is separated, the shell has been formed, and there is enough new bone to support the gravity of the limb. The principle of surgery is to completely remove the lesion, including dead bone, foreign bodies, sinus tracts, infected granulation tissue, and scarring, and to drain appropriately after surgery in order to completely cure osteomyelitis. Osteomyelitis surgery generally oozes a lot of blood and requires that it be performed under a tourniquet as much as possible and be prepared for blood transfusion.
V. Additional.
Rare primary bacteria causing chronic osteomyelitis: Salmonella.
Common in children and people with concurrent immune deficiency, such as lupus erythematosus, thalassemia, etc. It often occurs on the basis of multiple femoral infarcts (mostly in the long bone stem) and is easily missed because it is mostly hematogenous, has no obvious history of trauma, has atypical clinical manifestations, and has insignificant elevation of inflammatory indicators. The principles of treatment are the same as for chronic osteomyelitis.
At present, chronic osteomyelitis is characterized by a long treatment period, easy recurrence, significant bone destruction, limb dysfunction and other complications, and requires the joint efforts of patients and physicians to effectively control the infection.