Chronic Osteomyelitis of Tibia — Classification, Clinical Features and Management
DNB Orthopaedics • May 2024 • Paper II • 10 Marks
Introduction
Chronic osteomyelitis is a persistent or recurrent infection of bone characterized by devitalized bone, bacterial biofilm, impaired vascularity and, commonly, a sinus tract.
The tibia is especially vulnerable because of its subcutaneous location, limited soft-tissue envelope and high incidence of open fractures. Chronic tibial osteomyelitis commonly follows an open fracture, previous fixation, inadequate debridement or fracture-related infection.
Core principle: Antibiotics alone rarely eradicate chronic osteomyelitis when sequestrum, biofilm or avascular tissue remains. Successful treatment requires radical debridement plus appropriate reconstruction.
Pathological Hallmarks
Persistent bone infection
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Inflammation + thrombosis of vessels
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Bone ischemia and necrosis
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SEQUESTRUM
(dead avascular bone)
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Reactive new bone around infection
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INVOLUCRUM
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Opening through involucrum
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CLOACA
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Discharging sinus
Sequestrum
Devitalized piece of bone separated from living bone.
Involucrum
Reactive new bone surrounding sequestrum.
Cloaca
Opening in involucrum permitting discharge.
Sinus
Tract connecting infected focus to skin surface.
A. Classification
1. Waldvogel Classification
| Type | Mechanism |
|---|---|
| Hematogenous | Blood-borne infection |
| Contiguous-focus | Spread from adjacent wound/trauma/surgery |
| With vascular insufficiency | Typically associated with compromised limb perfusion |
| Chronic osteomyelitis | Persistent/recurrent infection with necrotic bone |