title: Diagnosis and treatment of pyogenic bone infections.
abstract: BACKGROUND
  Pyogenic osteomyelitis is still frequently seen in the developing world and the treatment of chronic osteomyelitis presents a considerable challenge despite advances in microbiological techniques, antibiotics and surgical techniques. Acute haematogenous osteomyelitis is commoner in children.
  
  
  RESULTS
  In the pre-antibiotic era, mortality rate was high and progression to chronic osteomyelitis was common. A near similar scenario still exists in many developing countries due to the combination of inappropriate and/or inadequate antibiotic therapy, delayed presentation and unorthodox interventions by traditional healers.
  
  
  CONCLUSIONS
  Chronic osteomyelitis may result from poorly treated or untreated acute osteomyelitis, open fractures, surgery for an array of orthopaedic conditions and from contiguous spread from infected soft tissue as may occur in diabetic foot infections. A large array of treatment techniques hinged on sequestrectomy/ debridement, management of dead space, improvement of oxygenation and perfusion to ischaemic tissue exist. Despite these, total eradication of disease is difficult.
  
  
  CONCLUSIONS
  This article summarizes the pathology and methods of management available for pyogenic osteomyelitis. In its acute and chronic forms, the disease is likely to remain prevalent in the developing world until issues of ignorance, poverty and prompt access to appropriate and efficacious medical care are addressed.
authors.affiliation: Department of Surgery, University of Calabar Teaching Hospital, Nigeria. iaikpeme@yahoo.com
authors.forename: I A
authors.initials: IA
authors.lastname: Ikpeme
authors.forename: N E
authors.initials: NE
authors.lastname: Ngim
authors.forename: A A
authors.initials: AA
authors.lastname: Ikpeme
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003646:Debridement; D057210:Delayed Diagnosis; D003906:Developing Countries; D006801:Humans; D010019:Osteomyelitis / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Arch Orthop Trauma Surg. 2005 Jul;125(6):369-75
references.pmid: 15965701
references.citation: Chang Gung Med J. 2005 Sep;28(9):651-6
references.pmid: 16323557
references.citation: J Bone Joint Surg Br. 1994 Mar;76(2):306-10
references.pmid: 8113299
references.citation: Pediatrics. 1997 Jun;99(6):846-50
references.pmid: 9190554
references.citation: Afr Health. 1992 Nov;15(1):27-8
references.pmid: 12285913
references.citation: Int Orthop. 2001;25(2):127-31
references.pmid: 11409452
references.citation: Postgrad Med J. 2000 Aug;76(898):479-83
references.pmid: 10908375
references.citation: Int Orthop. 2008 Dec;32(6):821-7
references.pmid: 17611757
references.citation: Spine (Phila Pa 1976). 2007 Oct 15;32(22):2480-6
references.pmid: 18090089
references.citation: Acta Orthop Belg. 2002 Oct;68(4):381-7
references.pmid: 12415941
references.citation: J Am Acad Orthop Surg. 2001 May-Jun;9(3):166-75
references.pmid: 11421574
references.citation: Afr Health Sci. 2006 Dec;6(4):236-9
references.pmid: 17604513
references.citation: Drugs. 1997 Aug;54(2):253-64
references.pmid: 9257081
references.citation: Curr Probl Pediatr. 1996 Aug;26(7):218-37
references.pmid: 8889387
references.citation: Int Orthop. 2008 Dec;32(6):835-40
references.pmid: 17589843
references.citation: Med J Aust. 1990 Jul 16;153(2):91-6
references.pmid: 2195307
references.citation: J Bone Joint Surg Am. 2004 Oct;86(10):2305-18
references.pmid: 15466746
references.citation: Am Fam Physician. 2001 Jun 15;63(12):2413-20
references.pmid: 11430456
references.citation: Asian Spine J. 2007 Dec;1(2):75-9
references.pmid: 20411128