title: Diagnosis and management of chronic infection.
abstract: High-energy penetrating extremity injuries are often associated with severe open fractures that have varying degrees of soft-tissue contamination and tenuous soft-tissue coverage. The result is a relatively high prevalence of chronic osteomyelitis compared with that in civilian trauma patients. Diagnosing chronic osteomyelitis requires a careful history and thorough physical and radiographic examinations. Cross-sectional imaging can help delineate the extent of bony involvement, and scintigraphy can be used as a diagnostic tool and to gauge response to treatment. Clinical staging also directs surgical management. Adequacy of débridement remains the most important clinical predictor of success; thus, adopting an oncologic approach to complete (ie, wide) excision is important. Reconstruction can be safely performed by a variety of methods; however, proper staging and patient selection remain critical to a successful outcome. Although systemic and depot delivery of antibiotics plays a supporting role in the treatment of chronic osteomyelitis, the ideal dosing regimens, and the duration of treatment, remain controversial.
authors.affiliation: Department of Orthopaedic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Jonathan Agner
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Benjamin Kyle
authors.initials: BK
authors.lastname: Potter
authors.forename: George
authors.initials: G
authors.lastname: Cierny
authors.forename: Lawrence
authors.initials: L
authors.lastname: Webb
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003646:Debridement / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D011379:Prognosis; D012720:Severity of Illness Index; D014946:Wound Infection / Q000145:classification / Q000175:diagnosis / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents