[Chronic treatment refractory osteomyelitis of long tubular bones--possibilities and risks of intramedullary boring].

Osteomyelitis of long bones is a severe complication of fracture healing. If on-going infection occurs despite reoperation and if antibiotic treatment is of no benefit, reaming of the medullary canal has been considered beneficial. We investigated long-term follow-up (minimum 2 years) in patients submitted to reaming of the medullary canal to evaluate the efficacy of this method. Criteria for success were: no recurrence and no further antibiotic treatment necessary. Of 37 patients, 32 were followed up (mean duration after reaming, 3.7 years). The mean number of surgical operations for osteomyelitis prior to reaming was 3.2. In 88% of patients a full range of motion was observed upon reexamination, while in the others stiffness attributable to articular injuries that had been sustained preoperatively was still present. We found that 84.3% of patients were working in the same profession as prior to the fracture, 72% were involved in sport again, and 97% of patients were pain free. One otherwise healthy patient suffering from sclerosing osteitis (Garré) died of bone marrow embolism into the lung during reaming of the femur. Reaming of the medullary canal has a high cure rate in osteomyelitis even after several previous treatment attempts with surgical revision and/or antibiotic medication. The mechanism is most probably based on improvement of local perfusion. During surgery care must be taken not to provoke pulmonary embolization. Intraoperative monitoring by pulmonary artery catheter should be performed; reaming should be discontinued immediately, if a rise in of pulmonary artery pressure occurs.(ABSTRACT TRUNCATED AT 250 WORDS)