Bone Infection: Treatment
Mild Bone Infection Treatment Steps
1. Surgical procedure: Mild infection can be treated with a surgical procedure that cleans out the bone. The bone is accessed by a variety of approaches through the skin. An orthopedic surgeon who specializes in bone infection or osteomyelitis can determine the best surgical approach for you.
2. Locally administered antibiotics: After the bone is surgically cleaned out, the remaining bone defect is treated with a large dose of locally administered antibiotics. The antibiotics can be delivered by using nonresorbable bone cement or an absorbable mix of synthetic bone substitute. Nonresorbable bone cement needs to be removed and replaced with bone graft by subsequent surgical procedures. The absorbable mix does not require subsequent surgery.
3. Antibiotic therapy: After the bone has been cleaned out and antibiotics have been administered locally, antibiotic therapy is required for six weeks to eradicate any remaining bacterial cells in the bone and bloodstream. The antibiotic therapy can be administered orally or through an intravenous catheter. The determination of which method to use can be made once the bacteria that infected the bone are identified by laboratory results of surgical samples.
Severe Bone Infection Treatment Steps
1. Surgical procedure: As with mild infection, severe infection can be treated with surgical cleansing of the bone. The bone can be accessed by a variety of approaches through the skin, and an orthopedic surgeon who specializes in bone infection or osteomyelitis can determine the best surgical approach.
2. Local antibiotics: As with mild infection, the bone defect that remains after surgical cleansing is treated with a large dose of locally administered antibiotics via nonresorbable bone cement, which requires subsequent surgery for removal and replacement with bone graft, or via an absorbable mix of synthetic bone substitute, which does not require subsequent surgery.
3. Weight bearing: With severe infection, after bone cleaning the bone is not strong enough to bear weight. Many techniques are available to rebuild bone after the bone cleaning procedure has been performed and after antibiotics have been administered locally.
4. Bone rebuilding: Temporary structural stability can be achieved with external fixation while the infection is being eradicated. Bone rebuilding techniques can involve bone grafting or bone transport that is achieved with the use of a special Ilizarov external fixator. The fixator can remain in place for several months depending on how much bone was lost as a result of the infection.
5. Antibiotic therapy: Severe infections require six weeks of antibiotic therapy that is specific to the bacteria that were present in the bone.
Bone Infection Treatment Images
Images of a 31-year-old patient with juvenile diabetes who suffered a ski boot injury.
Left image: Antibiotic cement rod
Right image: Wound vac to heal abscess
External fixation was used to achieve deformity correction. Concurrently, antibiotic beads were used to treat osteomyelitis.
Radiographs show final result of healed, noninfected bone.
Images from the case of a 40-year-old man with severe osteomyelitis after trauma. Treatment consisted of resection and bone transport.
Radiographs show lateral and anteroposterior views of external fixation, which was used in the process of bone rebuilding.
Radiographs show final result.