Surgical removal of metallic foreign body (shrapnel) from the lumbosacral spine and the treatment of chronic osteomyelitis: a case report.

We report a case of a retired soldier who was severely injured by an explosion in 1993 during the war in Bosnia and Herzegovina. Among other wounds, he suffered an explosive wound in the lumbosacral spine with steel foreign body (shrapnel). A year after primary wound treatment, a purulent fistula appeared which was treated and stopped with antimicrobial therapy. Subsequently, fistula which was activated several times after the antibiotic therapy was discontinued, but in the last eight years, the fistula has been continuously present so the patient decided on surgery. During surgery, the shrapnel was removed from the lumbosacral spine and there was debridement of necrotic bone. During two weeks of peri-operative and postoperative period, chronic osteomyelitis was treated by intravenous ciprofloxacin and gentamycin, and after that by a combination of rifampicin and trimethoprim-sulfamethoxazole orally, for six months. The patient did not show any signs of infection after two years of follow-up.