Osteomyelitis Sharon Babcock MD Wake Forest Baptist Health

Osteomyelitis Sharon Babcock, MD Wake Forest Baptist Health SEFS 2020

Characteristics • Osteomyelitis • Infection of bone • Inadequate treatment of acute infection • Local soft tissue spread • Biofilm • High risk = HIV, DM, immunosuppressed, hepatitis, geriatric

Diagnosis I. Acute – short duration of symptoms, more intense clinical presentation II. Chronic – longer duration, sinus tract, subtle presentation, sequestrum III. Organism identification – multiple cultures IV. Greater treatment success in acute v chronic/recurrent

Excise necrotic bone & affected tissue Operative Treatment Goals

Chronic osteomyelitis

Bone Debridement • Saucerization • Create longitudinal channel over affected area and remove all affected bone • Intramedullary reaming • Make vent hole distally if no fracture • Consider Reamer Irrigator Aspirator (RIA) • Thorough irrigation

Successful treatment

Treatment

Single Stage Exchange • Prompt thorough debridement • Hardware exchange • 12 weeks biofilm active antibiotics

Two Stage Exchange

Two Stage Exchange • If NO biofilm active agent available, poor soft tissues, suppression not option • Hardware removal, temporary stabilization, 6 wk abx therapy • Reimplantation, 6 wks biofilm active therapy OR 2 wk holiday, monitor for signs, reimplant, stop abx 1 wk after cultures negative • Remember – instability makes infection eradication difficult – consider short ex fix period (1 -2 wk) then 12 wk abx therapy

Antibiotics • Key = high enough drug concentration bone/blood • IV not always necessary • • • Ciprofloxacin – biofilm active Amoxicillin Clindamycin Linezolid Metronidazole Rifampin – biofilm active, never alone • Only effective if reach site of infection

Chronic suppression w antibiotic therapy Non-Operative Treatment Goals

Amputation is Not Failure

Summary • Early identification/debridement • Identify organism • Culture directed therapy with BIOFILM activity • Remove implants if fracture healed • Minimize fracture motion if not healed • Communication/Goals of treatment

Thank You!