Update on chronic osteomyelitis. Anthony JP, Mathes SJ.

Source Department of Surgery, University of California, School of Medicine, San Francisco. Abstract Recent advances in the understanding of the pathophysiology and treatment of osteomyelitis have been discussed. Some of the advances (in either knowledge or technology) that we have found particularly useful include the following: The discovery of additional prognostic factors, which allow more reliable preoperative assessment. The development of the Ilizarov device, which allows bone fixation and later limb lengthening. Confirmation of the effectiveness of single-staged debridement and muscle flap closure. Confirmation that a brief (10 to 14 day) course of antibiotics is as effective as more prolonged therapy. The development of several new free muscle donor sites and a greater appreciation of the need for careful insetting of the muscle. The development of local antibiotic delivery systems, especially continuous antibiotic irrigation catheters. The development of newer oral and intravenous antibiotics that allow outpatient therapy following surgery. The recognition that patients require extended follow-up, and that any recurrences can be successfully treated with a second debridement and muscle flap closure. Secondary prevention Most cases of long-bone osteomyelitis are post-traumatic or postoperative. For the physician, preventative measures focus on reducing the odds that the chronic form of the infection will develop. Surgical debridement, wound irrigation, and muscle-flap or vascularised tissue grafts play major roles in prevention and treatment by removing dead tissue, decreasing bacterial load, and filling dead space with vascularised tissue. Culture-specific antibiotics also play a major role in decreasing the incidence of acute and chronic osteomyelitis. Internal fixation of contaminated dead bone inevitably leads to osteomyelitis and must be avoided. [88] If you've been told that you have an increased risk of infection, talk to your doctor about ways to prevent infections from occurring. Reducing your risk of infection will also reduce your risk of developing osteomyelitis. In general, take precautions to avoid cuts and scrapes, which give germs easy access to your body. If you do get any cuts and scrapes, clean the area immediately and apply a clean bandage. Check wounds frequently for signs of infection. 1998-2012 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance

your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Promotive Watch (name of person) for signs and symptoms listed above and report immediately to (title of person in agency who is responsible to receive this information). Give medication as ordered (see Medication Administration Record / Log). If a prn (as needed) is given, the results must be documented per agency policy. Include any specific instructions from the treating physician. For example, watching for side effects of antibiotic medication Documentation about this condition can be found in the medical record under (list section here). Receive training regarding this diagnosis and plan of care (include when to notify the physician) by (title of person who provides medical training) at least (indicate frequency of training) or as changes occur. This should be documented for all staff in the home. CHAPTER II Introduction of the Disease Do what you love. Know your own bone; gnaw at it, bury it, unearth it, and gnaw it still. -Henry David Thoreau Osteomyelitis is a local or generalized pyogenic disease of the bone, bon e marrow and surrounding tissue. In children, the disease usually results from untreatedacute hematogenous osteomyelitis. Chronic osteomyelitis may also be seen after traumatic injuries, especially in times of civil unrest or war, or as a complication of surgical procedures such as open reduction and internal fixation of fractures. The longbones are affected most commonly, and the femur and tibia account for approximatelyhalf of the cases. Predisposing factors include poor hygiene, anemia, malnutrition, anda coexisting infectious disease burden (parasites, mycobacteria, acquired autoimmunedeficiency syndrome), or any other factors that decrease immune function. Chronicosteomyelitis is defined by the presence of residual foci of infection (avascular bone andsoft tissue debris), which give rise to recurrent episodes of clinical infection. Eradication of the infection is difficult, and complications associated with both theinfection and their treatments are frequent. Our goals are to review the

pathophysiology,natural history, and management for children with chronic osteomyeliti s within thecontext of a developing world setting.

The human skeletal system is a complex set of bones and connective tissues that serve several functions in the body. One of the primary functions of the bones is to provide support and structure. You couldn't move well without a skeleton to attach muscles to. Instead you would slink about like a giant ameoba - not much fun. The radius is one of two bones found in the forearm of humans. This article will take a look at the basic anatomy of the human radius.

Despite a similar name, the radius has nothing whatsoever to do with the geometry term. It's not the distance from the center of any circle to the edge. There are two bones in the forearm of a human, the ulna and the radius. If you place a body in the anatomical position (laying flat, with the arms to the sides, hands facing forward), the radius is on the outside (lateral). If you trace a line from the tip of the thumb and follow the backside of the thumb toward the forearm, you'll be touching the radius. The upper end (called the proximal end) of the radius has an area that attaches to the humerus (the major bone in the upper arm) at the elbow joint. At the elbow joint, the radius also attaches the other bone in the forearm - the ulna. These bones are all connected with muscles and ligaments. There are many muscles attached to the main shaft of the radius. Anatomists generally agree that there are three surfaces to the radius (oddly, there are debates in anatomy regarding the naming and classification of some structures. They actually have conferences to argue about things like this. Bizarre.). They are the anterior, posterior, and lateral surface. Various muscles attach to different parts of these three surfaces. Near the wrist joint is the distal end of the radius. This is the thickest and largest part of the radius (it's the narrowest part of the ulna, which keeps your forearm from getting wider as you get closer to your hand.). The radius articulates with many of the bones in the wrist, specifically the lunate and scaphoid. The radius also attaches again to the ulna near the wrist. The radius and ulna do not make contact along the shaft. The radial artery can be felt as it runs near the surface against the radius just below the wrist. There are a variety of muscles attached to the radius at various points. THIS ARTICLE outlines some of the major muscle attachments to the radius.