Adult osteomyelitis

Adult osteomyelitis most commonly arises from open fractures, diabetic foot infections, or the surgical treatment of closed injuries. Patients usually have a history of prolonged debilitation and multiple surgical procedures. Treatment of osteomyelitis has improved considerably over the past quarter-century because of advances in diagnostic, surgical, and therapeutic techniques. The term cure is not used for osteomyelitis, because the infection may recur years after apparently successful treatment of the disease, if the patient suffers new trauma to the involved area, or the host response to the infection is suppressed. The goal of treatment is to arrest osteomyelitis, rather than achieve cure. This article provides a broad discussion of adult osteomyelitis. The major classification systems are reviewed, with brief discussions of hematogenous, vertebral, contiguous-focus, and chronic osteomyelitis. Diagnosis is discussed, with particular attention on the role of different radiologic technologies. Finally, the focus is various approaches to treatment for different types of adult osteomyelitis, including cases involving special patient populations.