Chronic osteomylitis

Frequency

Relatively infrequent. Most often as a result of an accident so localized in the legs, especially following a type III fracture . In diabetics, the infection is usually found in the foot, as a complication of an unrecognized sore since diabetics often have a loss of sensitivity (neuropathy).

Features

The patient complains of dull aches in the bone and the overlying skin may be slightly swollen and hot. The mobility of the neighboring joint can be reduced if the infection is in its vicinity. Sometimes there is the formation of a fistula that starts from the abscess and joins the skin. Pus can be released at regular intervals. The infection can persist for many years.

Diagnostics

Confirmation is done by x-rays, magnetic resonance, blood counts and pus cultures to determine the most effective antibiotic.

Evolution

Despite the use of modern antibiotics we face recurrences in 20-30% cases with recurrences that can last a lifetime. The steady increase in resistance antibiotics is likely to increase the number of these relapses .

Treatment

The treatment, which is above all surgical, may be prolonged. The infected parts as well as the abscess cavities must be excised and filled with bone grafts impregnated with powerful antibiotics. HBOT is useful here because it improves wound healing and accelerates the deflation of the operated tissues. In chronic cases, the preoperative treatment strengthens the tissues which improves the result of the surgical intervention. This may be less radical. There are also good results in patients under dialysis.

Practical use of HBOT

In cases of fresh osteomyelitis, 20 sessions after the operation are usually sufficient for a quick and safe recovery. In chronic osteomyelitis, for which the intervention took place a long time ago, we recommend 40 consecutive sessions like most chronic indications.