Long Bone Osteomyelitis.

Osteomyelitis is a complex disease that is often associated with high morbidity and considerable health care costs. Bacteremia, contiguous focuses of infection, penetrating trauma, or surgery are the major predisposing factors for this infection. Bone necrosis and bone destruction occur early in the course of osteomyelitis, leading to a chronic process and eliminating the host's ability to eradicate the pathogens. The presence of poorly vascularized tissues, the adherence to bone structures and implants, and a slow bacterial replication rate are recognized as important factors for the persistence of the infection. Treatment of osteomyelitis is particularly challenging and involves adequate antimicrobial therapy and surgical debridement of all necrotic bone and soft tissues. Antibiotic treatment is usually started on an empiric basis and then modified according to the results of cultures and sensitivity tests. Surgical treatment consists of debridement, obliteration of dead space, adequate soft tissue coverage, restoration of blood supply, and stabilization.