Abstract: There has been a definite change in the natural history of vertebral osteomyelitis. At the turn of the century the disease was most often seen in younger people, accompanied by a high incidence of abscess formation and associated with a high mortality rate. Today the disease is more commonly seen in the older age groups and is only occasionally characterized by abscess formation. In addition it tends to be of a lower grade inflammatory reaction and has a better prognosis. A urinary tract infection is a common pre-existing condition. Diagnosis may be difficult particularly before the onset of destructive changes radiologically at 8 to 12 weeks. Biopsy by either open or closed methods might be necessary to establishe the diagnosis and isolate the causative organism which is usually Staphylococcus aureus. Epidural infection is the most devastating complication, particularly if neglected. The duration of treatment is determined by following the clinical symptoms, sedimentation rate, temperature curve and interval radiological changes. The prognosis is good and most patients will recover within one year.

Abstract: Although chronic osteomyelitis resulting from untreated acute osteomyelitis is no longer often seen in developed countries, it is still relatively common as a sequelae from open fractures or gunshot wounds. Principles of treatment for chronic osteomyelitis remain constant regardless of etiology. The classic form of chronic osteomyelitis had its onset with acute osteomyelitis, as the abscess was forming and the involved bone was ischemic. If the amount of ischemic bone was substantial, it would remain as a sequestrum. Especially if the sequestrum was contaminated, it would remain as a focus of recurring infection; even if not contaminated, it's presence activated a host response similar to that of a foreign body an attempt to wall off the sequestrum. The new bone reacting to the sequestrum is called the involucrum. Chronic osteomyelitis is clinically evident by low grade drainage and inflammation about the infected site. Pathologic fracture or nonunion may accompany chronic osteomyelitis. The quality of the adjacent soft tissue may be poor, depending on etiology. Treatment of chronic osteomyelitis in adults is sometimes compared to treating entities such as giant cell tumors, in that a radical resection of the infected bone is the first step, followed by efforts at reconstruction. The classification of Cierny is modeled on tumor classification.

Abstract: Eighteen cases of bone and joint tuberculosis in children were diagnosed in the Stockholm region (about 1,500,000 population) over the period 1961-1974. BCG infection was verified by culture and identification of bacterial type in seven, all after 1968. The same origin can be presumed in most of the remaining eleven cases, in spite of the absence of bacterial verification. The increased frequency of complications after BCG vaccination may necessitate a revision of the vaccination programme. We recommend operative treatment, which has not led to any growth disturbances or impairment of joint function, although the lesions were invariably localised close to growth zones and joints.

Abstract: Nonunion of the mandible was evaluated over a five-year period (1968-1973). Fourteen cases were noted out of 577 mandibular fractures for an incidence of 2.4 percent. Causes of the complications were determined by a careful review of the poorly healing and successfully treated cases of mandibular fracture. The most important feature in nonunion cases was the large proportion of edentulous patients. In these cases immobilization appeared difficult, especially when only one form of fixation was used to stabilize the fracture. Other suspected causes of nonunion were postoperative trauma and osteomyelitis. These factors were most prevalent in the lower socio-economic groups. Factors which did not appear important were sex, age and cause of the fracture. Analysis of the site of injury, combinations of sites, timing of treatment, periosteal stripping and general health of the patient failed to demonstrate any predisposition to the complication. Treatment of nonunion was confined to standard techniques of debridement, antibiotic therapy and further immobilization. Although most patients responded to this therapy, six patients required closure of the deficit by bone grafting. On the basis of accumulated data, it was possible to clarify the factors in the development of nonunion. It was also possible to recommend methods of prevention of the complication and to substantiate the success of several forms of therapy.

Abstract: Although destructive bone disease is a well-known complication of tertiary syphilis, osteitis or osteomyelitis are not commonly recognized as complications of early (primary or secondary) syphilis. A patient with secondary syphilis characterized by generalized lymphadenopathy, perianal condyloma lata, and positive rapid plasma reagin (RPR) and fluorescent treponemal antibody-absorption (FTA-ABS) tests also complained of headache, right shoulder pain, and right anterior chest pain and swelling. Roentgenograms showed mottled osteolytic lesions consistent with previously described luetic bone disease. Biopsy confirmed the diagnosis of syphilitic osteomyelitis, and treatment with penicillin resulted in prompt resolution of symptoms. ( JAMA 236:2646-2648, 1976)

Abstract: Seven cases of gram-negative osteomyelitis following puncture wounds of the foot are presented. Regardless of age (range, five to thirty-two years) all patients had a similar, typical clinical picture of one to two weeks of improvement after the initial post-traumatic inflammation followed by worsening of the local signs. Two patients were successfully treated with antibiotics alone and five, with antibiotics in combination with curettage.

Abstract: Eikenella corrodens was isolated from an orally contaminated hand wound which resulted in cellulitis, osteomyelitis, and arthritis. E corrodens is a gram-negative, microaerophilic bacillus which only lately has received attention as a possible pathogen. The organism grows characteristically as small, corroding, or pitting colonies on blood agar. It typically requires hemin or blood for reliable aerobic growth. Oral contamination of wounds predisposes to infection with E. corrodens. The management of these infections includes treatment with an effective antibiotic and surgical debridement. Because it is gram-negative, microaerophilic, and often difficult to isolate, infections caused by E corrodens may mimic those caused by gram-negative obligate anaerobes. However, E corrodens is resistant to clindamycin and lincomycin and sensitive to most other commonly used antimicrobial agents.

Abstract: A case of chronic, multifocal hematogenous osteomyelitis in a child is descirbed. It represents a special, well-defined clinical variant of this disease, which obviously reflects a more or less balanced relationship between the bacterial aggressor and the defense mechanisms. Exacerbations of old processes, and spread to new sites, can be ascribed to a temporary imbalance.

Abstract: In osteomyelitis, bone-scan findings precede the appearance of bone changes on radiographs. In cases where focal ischemia occurs, the earliest scan finding may be a "cold" area that later becomes "hot" as active periostitis develops.

Abstract: An account is given of results of the radiologic examination of 29 infants and children with bone tuberculosis caused by the Bacilli Calmette-Guerin (BCG) as a complication to intradermal vaccination. The diagnosis is based on radiologic appearances, microscopy and bacteriologic examination of specimens obtained from the bone lesions. The radiologic appearance of the bone lesions is in most cases characteristic and differs decisively from that of pyogenic osteomyelitis and malignant disease.

Abstract: • Pyogenic osteomyelitis of the cervical spine was successfully treated without bone grafting in 11 of 12 patients. Staphylococcus aureus was the most common organism. Four of the patients were heroin addicts, and six others had received parenteral injections under medical supervision. The patients were immobilized promptly, and after diagnostic procedures, cultures, and drainage when appropriate, they were treated with antibiotics, which led to spontaneous fusion in the 11 who survived. In the preantibiotic era, these infections frequently evolved into "epidural abscess," with resultant cord compression leading to permanent paralysis or death. Therefore, early differential diagnosis from tuberculosis or cancer is necessary. Today, with early diagnosis, immobilization, an anterior surgical approach when necessary, and the appropriate antibiotic, cure without neurological deficit should be the rule.

Abstract: A case of occult pelvic osteomyelitis is presented The involved portions of the left pubis and left ischium presented as "cold" areas on the original bone scan with 99mTc-diphosphonate The presumed mechanism for this unusual finding in osteomyelitis is compression of the microcirculation to bone by subperiosteal and intraosseous pus

Abstract: Free omental transplantation with vascular anastomosis was attempted in three clinical cases as a new method of treatment for chronic osteomyelitis. The bone cavity produced by debridement was comp...

Abstract: Review of the laboratory and clinical findings and treatment of eight patients with osteomyelitis of the foot after puncture wounds revealed that: 1) osteomyelitis after puncture wounds is a infrequent but potentially serious complication, with significant morbidity; 2) osteomyelitis is frequently preceded by inadequate primary care for simple puncture wounds, and when treatment is appropriate, osteomyelitis usually can be avoided; 3) P aeruginosa is the most commonly recovered organism; 4) the clinical presentation is characterized by a lack of systemic toxicity, paucity of laboratory abnormalities, and evidence of a localized infection process and the patient may be asymptomatic for a few days to several months after the injury before presentation of the osteomyelitis; and 5) once the infection has become established, treatment must be aggressive, including surgical debridement

Abstract: Two cases of vertebral sarcoidosis in pediatric patients are presented. All such patients reported have been black, 13–15 years old, and have a history of back pain. Radiographs of the involved vertebrae show primarily lytic destruction with sclerotic borders in some of the lesions. Fungal infections, tuberculosis, pyogenic osteomyelitis, Hodgkin's disease, and metastatic disease must be considered in every patient with vertebral sarcoidosis.

Abstract: ✓ The authors report a rare case of a brain abscess associated with osteomyelitis caused by Salmonella typhi that remained in contact with human tissues for 33 years without losing its virulence.