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Osteomyelitis

Osteomyelitis is an infection of bone caused most commonly by bacteria, particularly Staphylococcus aureus. Acute osteomyelitis usually presents with pain, fever, local tenderness, swelling, and raised inflammatory markers, while chronic osteomyelitis is characterized by persistent or recurrent infection with features such as sequestrum, involucrum, cloaca, and discharging sinus. Treatment combines appropriate antibiotics with surgical drainage or debridement when necessary.

Osteomyelitis is an inflammatory infection of bone and bone marrow that may occur through haematogenous spread, direct inoculation following trauma or surgery, or contiguous spread from adjacent soft-tissue infection. The causative organism is most commonly Staphylococcus aureus, although the microbiological profile varies with age, comorbidities, mechanism of infection, and implant status. Acute osteomyelitis typically develops rapidly and is characterized by bone pain, fever, local warmth, swelling, tenderness, and reduced use of the affected limb. Laboratory investigations may show elevated CRP, ESR, and white-cell count. Plain radiographs may initially be normal, while MRI is highly sensitive for early detection and assessment of marrow and soft-tissue involvement. Blood cultures and tissue cultures help identify the causative organism. Chronic osteomyelitis develops when infection persists because of necrotic bone, inadequate treatment, compromised vascularity, or biofilm formation. Characteristic features include sequestrum, involucrum, cloaca formation, sclerosis, deformity, and a persistent or intermittent discharging sinus. Long-standing infection may be associated with complications such as pathological fracture, growth disturbance, amyloidosis, and rarely malignant transformation of a chronic sinus tract. Management depends on the stage and severity of infection. Acute disease is treated with culture-directed antibiotics, with surgical drainage if there is abscess formation or failure of medical treatment. Chronic osteomyelitis usually requires radical debridement of all necrotic and infected tissue, removal of infected implants when appropriate, dead-space management, restoration of stability, and prolonged targeted antimicrobial therapy. The overall goals are to eradicate infection, preserve viable bone and soft tissue, restore mechanical stability, and maintain limb function.

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Patellar instability

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Osteomyelitis

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