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Category: Volume 06 Issue 01 January 2018
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Title: Chronic Osteomyelitis in Adults: A Prospective Study

Authors: Dr Vishwas Sharad Phadke, Dr Satish Divakar Mehta, Dr Sunil V.Patil

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.120

Abstract

Background: Osteomyelitis is inflammation of the bone caused by an infecting organism. It is divided into acute, subacute and chronic osteomyelitis on the basis of the duration from the onset of symptoms to the definitive diagnosis. The common predisposing factors for development of chronic osteomyelitis are diabetes, immunosuppression, individuals on immunosuppressants, chemotherapeutic agents or on steroids. The management of chronic osteomyelitis is challenging and consist of prolonged course of appropriate antibiotics and surgical interventions (skin or bone grafting, debridement, drainage of pus and amputation in unrelenting infections).

Aims and Objectives: (1) To study the factors predisposing an individual for the development of chronic osteomyelitis. (2) To know the common bones and type of organisms involved in chronic osteomyelitis.

(3) To study the outcome of cases after appropriate management.

Methods: This was a prospective study in which patients of more than 18 years of age and having been diagnosed with chronic osteomyelitis were enrolled on the basis of predefined inclusion and exclusion criteria. The institutional ethical committee approved the study. Informed consent was taken from all the patients. Demographic details, clinical features, associated comorbidities and involved bone were all noted down in a predefined proforma. Diagnosis was confirmed by imaging and culture sensitivity. Patients were managed by surgical interventions and prolonged antibiotics. Patients were followed up for 1 year and outcome was studied.

Results: Out of 45 studied cases males were affected predominantly with a M: F ratio of 1:0.6. Most common age group affected was found to be between 41-50 years. Most common bones involved were femur (28.88%) and tibia (26.66%) followed by fibula (11.11%), iliac bones (6.66%) and humerus (6.66 %). In most of the cases (35/45) contagious spread following trauma was the mechanism of infection. Comorbidities like hypertension, diabetes and immunosuppression was present in 44.44% patients. S. Aureaus (17/45) followed by Pseudomonas (9/45) or enterococci (6/45) were the most common pathogens isolated by appropriate culture methods. Finally the analysis of outcome showed that 28 patients were completely cured while remaining patient had some or the other problem associated with chronic osteomyelitis. 3 patients died during study period due to causes unrelated to osteomyelitis.

Conclusion: Management of chronic osteomyelitis is a challenge for treating orthopedicians. Appropriate surgical interventions and suitable antibiotics for prolonged periods are required. Inadequate treatment is fraught with the danger of complications.

Keywords: Chronic Osteomyelitis, risk factors, Management, Outcome.

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Corresponding Author

Dr Satish Divakar Mehta

Assistant Professor in Orthopaedics,

Bharati Vidyapeeth Deemed University Medical College, Sangli (Maharashtra) India