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Background The prevalence of diabetes mellitus continues to inexorably rise in the United States and throughout the world. Lower limb amputations are a devastating comorbid complication of diabetes mellitus. Osteomyelitis increases the risk of amputation fourfold and commonly presages death. Antimicrobial therapy for diabetic foot osteomyelitis (DFO) varies greatly, indicating that high quality data are needed to inform clinical decision making. Several small trials have indicated that the addition of rifampin to backbone antimicrobial regimens for osteomyelitis outside the setting of the diabetic foot results in 28 to 42% higher cure rates. Methods/design This is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for DFO. The study population are patients enrolled in Veteran Health Administration (VHA), ages ≥18 and ≤ 89 years with diabetes mellitus and definite or probable osteomyelitis of the foot for whom an extended course of oral or intravenous antibiotics is planned. The primary endpoint is amputation-free survival. The primary hypothesis is that using rifampin as adjunctive therapy will lower the hazard rate compared with the group that does not use rifampin as adjunctive therapy. The primary hypothesis will be tested by means of a two-sided log-rank test with a 5% significance level. The test has 90% power to detect a hazard ratio of 0.67 or lower with a total of 880 study participants followed on average for 1.8 years. Discussion VA INTREPID will test if a rifampin-adjunctive antibiotic regimen increases amputation-free survival in patients seeking care in the VHA with DFO. A positive finding and its adoption by clinicians would reduce lower extremity amputations and their associated physical and emotional impact and reduce mortality for Veterans and for the general population with diabetic foot osteomyelitis. Given that rifampin-adjunctive regimens are currently employed for therapy for the majority of DFO cases in Europe, and only in a small minority of cases in the United States, the trial results will impact therapeutic decisions, even if the null hypothesis is not rejected. Trial registration Registered January 6, 2017 at ClinicalTrials.gov, NCT03012529 .

The aim of this study was to investigate the effect of vacuum sealing drainage (VSD) treatment on surgical indicators, inflammatory factors, and functional recovery in patients with chronic osteomyelitis secondary to open tibial fractures. In total, 87 patients with secondary bone infection after internal fixation of tibial fracture treated in the Affiliated Hospital of Shandong Second Medical University from December 2020 to June 2022 were selected, all of whom were tibial shaft fractures. Of these, 55 cases of primary open fracture were sutured in the first stage; 32 cases underwent internal fixation after primary debridement at the time of trauma. The patients were treated with surgical debridement, removal of internal fixation, and fixation with an external fixation frame. After debridement, those with local wounds that could not be completely closed and were complicated with exposed bone were randomly selected for either VSD covering treatment (study group, n=46) or bone cement covering treatment (control group, n=41. The distribution of pathogenic bacteria, surgical indicators, inflammatory factors [tumor necrosis factor⁃α(TNF⁃α), interleukin⁃6 (IL⁃6), and C⁃reactive protein (CRP) levels], functional recovery [knee, ankle, and limb function recovery], and complications were summarized. There were 87 pathogenic bacteria strains in 87 patients, including 43 Gram⁃positive bacteria strains (49.42%), 32 Gram⁃negative bacteria strains (36.78%), and 12 fungi strains (13.80%). The number of dressing changes in the study group was less than that in the control group. The infection control time, wound sterility time, hospitalization time, and skin flap transfer operation time in the study group were shorter than those in the control group and the difference was statistically significant (P<0.05). After treatment, the levels of TNF⁃α, IL⁃6, and CRP in the two groups decreased, among which the change in the study group was the most significant and the difference between the two groups was statistically significant (P<0.05). After treatment, the Hospital for Special Surgery Knee Score and Baird-Jackson score of the two groups increased, among which the change in the study group was the most significant and the difference between the two groups was statistically significant (P<0.05). The excellent and good rate of the study group (95.65%) was higher than the excellent and good rate of the control group (80.49%) and the difference was statistically significant (P<0.05). When a wound cannot be closed, VSD treatment of patients with secondary bone infection after internal fixation of tibial fracture can improve the level of surgical indicators and inflammatory factor levels in patients, and promote the recovery of patients' limb function, and is thus worthy of clinical promotion and application.

There is growing evidence that childhood surgical conditions, especially injuries, are common in developing countries and that poor care results in significant numbers of deaths and cases of disability. Unfortunately, however, surgical care is not considered an essential component of most child health programmes. Strategies for improving paediatric surgical care should be evidence-based and cost-effective and should aim to benefit the largest possible number of children. The most likely way of achieving policy change is to demonstrate that childhood surgical conditions are a significant public health problem. For paediatric purposes, special attention should also be given to defining a cost-effective package of surgical services, improving surgical care at the community level, and strengthening surgical education. Surgical care should be an essential component of child health programmes in developing countries.

This study was designed to observe the clinical outcome of anterior versus posterior instrumentation in the treatment of Pyogenic vertebral osteomyelitis of the lumbar spine. Twenty-three patients underwent either anterior (anterior fixation group) or posterior fixation (posterior fixation group) combined with a single-stage anterior radical debridement and had an average follow-up of 38 months. Clinical evaluation was performed using the Oswestry Disability Index and visual analog scale. Serial tests of the erythrocyte sedimentation rate and C-reactive protein levels were used to monitor for infection recurrence. Radiography was performed pre- and postoperatively to assess the deformity correction and for bony fusion. Serial erythrocyte sedimentation rate and C-reactive protein levels reflect the active state of infection and can guide postoperative treatment. Patients in the anterior fixation group showed significantly better results on the Oswestry Disability Index than those in the posterior fixation group 2 years postoperatively. The visual analog scale values demonstrated a significant difference between the 2 groups at 1 and 2 years postoperatively, with pain significantly improved in the anterior fixation group. Radiological results showed no significant difference in fusion time, deformity correction, and cage subsidence. Both anterior and posterior fixation had satisfactory outcomes and were reliable and safe for the treatment of Pyogenic vertebral osteomyelitis of the lumbar spine. Patients with anterior fixation may achieve better postoperative results, such as better well being and less pain.

Unless acute osteomyelitis in children is diagnosed promptly and treated appropriately, it can be a devastating or even fatal disease. This review summarizes the current approach to the treatment of acute osteomyelitis in children. Bacteria may reach bone through direct inoculation from traumatic wounds, by spreading from adjacent tissue affected by cellulitis or septic arthritis, or through hematogenous seeding. In children, an acute bone infection is most often hematogenous in origin. 1 In high-income countries, acute osteomyelitis occurs in about 8 of 100,000 children per year, 2 but it is considerably more common in low-income countries. Boys are affected twice as often as girls. 2 , 3 Unless acute osteomyelitis is diagnosed promptly and treated appropriately, 4 it can be a devastating or even fatal disease with a high rate of sequelae, especially in resource-poor countries where patients present . . .

Osteomyelitis is a destructive disease of bone tissue caused by infection with pathogenic microorganisms. Because of the complex and long‐term abnormal conditions, osteomyelitis is one of the refractory diseases in orthopedics. Currently, anti‐infective therapy is the primary modality for osteomyelitis therapy in addition to thorough surgical debridement. However, bacterial resistance has gradually reduced the benefits of traditional antibiotics, and the development of advanced antibacterial agents has received growing attention. This review introduces the main targets of antibacterial agents for treating osteomyelitis, including bacterial cell wall, cell membrane, intracellular macromolecules, and bacterial energy metabolism, focuses on their mechanisms, and predicts prospects for clinical applications. Various antibacterial agents are developed vigorously for osteomyelitis therapy, including metal‐based antibacterial agents, antibiotics, antibacterial peptides, antibacterial proteins, antibacterial cationic polymers, and so forth, which usually play an anti‐infective role by acting on the targets of cell wall, cell membrane, intracellular macromolecules, and energy metabolism, providing support for the comprehensive treatment of osteomyelitis.

Background Emphysematous Osteomyelitis is a rare and potentially fatal form of severe osteomyelitis. It is characterized by gas produced by pathogenic bacteria accumulating in bone structures and surrounding soft tissues. Its rarity and severe nature pose significant challenges for diagnosis and treatment. This case report describes the diagnosis and treatment of Emphysematous Osteomyelitis of the spine in a patient with long-term malnutrition and anemia. Case presentation A 72-year-old agricultural worker presented with persistent low back pain accompanied by radiating pain in both lower limbs for one month. The patient reported continuous dull pain that worsened with postural changes and improved when lying flat. Based on clinical presentation, biochemical indicators, and imaging studies, spinal infection was initially suspected. Empirical antimicrobial therapy administered for two weeks after admission proved ineffective and was complicated by an epidural abscess, leading to the decision for surgical intervention in the third week. Intraoperative tissue samples were identified through culture identification and high-throughput culture and metagenomic pathogen detection, identifying Citrobacter koseri and Staphylococcus aureus as causative pathogens. Postoperatively, based on antimicrobial susceptibility testing results, treatment was switched to intravenous meropenem and levofloxacin. One month postoperatively, the patient showed good recovery with normalized infection markers, no fever, and significant pain relief. Discussion and conclusion In summary, this rare and severe form of Emphysematous Osteomyelitis requires prompt diagnosis and treatment in clinical practice. The diagnosis of Emphysematous Osteomyelitis of the spine relies on imaging studies. Failure to achieve accurate and timely diagnosis may lead to misdiagnosis or delayed treatment, which not only compromises therapeutic efficacy but may also result in catastrophic consequences. Timely antibiotic therapy, early detection, and aggressive surgical intervention when necessary are key to the successful management of Emphysematous Osteomyelitis of the spine. Highlights Diagnosing and treating spinal infections poses significant challenges. When rare spinal infections occur, prompt diagnosis and treatment are essential for achieving a favorable prognosis. Emphysematous Osteomyelitis of the spine often requires surgical intervention to achieve optimal therapeutic outcomes. Following intraoperative sampling and testing, treatment should be immediately switched to appropriately sensitive antibiotics. This case underscores that prompt diagnosis and treatment are essential for favorable outcomes when rare cases of Emphysematous Osteomyelitis of the spine occur.

Background High-energy lower extremity crush injuries with concurrent infection and segmental bone defects present significant therapeutic challenges, often complicated by recalcitrant osteomyelitis and compromised bone healing. Traditional approaches frequently fail to achieve simultaneous infection eradication and structural reconstruction. This case demonstrates how a staged surgical protocol combining bone transport and antibiotic cement spacer technology addresses these dual challenges. Case report A 45-year-old male sustained an open tibiofibular fracture of the left lower extremity with extensive soft tissue loss after a traffic accident. He initial underwent open reduction and internal fixation (ORIF) with titanium plates and external fixation. Subsequently, he developed chronic osteomyelitis caused by Escherichia coli. A multidisciplinary team implemented a four-phase protocol: Phase I (Feb–Jun 2020): Radical debridement, removal of infected titanium plate, split-thickness skin grafting, and triangular external fixation. Phase II (Jun–Jul 2020): Ilizarov circular frame application and vancomycin/tobramycin-impregnated bone cement implantation after further debridement. Phase III (Jul 2020–Mar 2021): Bone transport initiated at 1 mm/day to reconstruct a 20 cm tibial defect using a hybrid Ilizarov-U frame. Phase IV (Mar 2021–Feb 2022): External fixator removal after radiographic consolidation, followed by fibular titanium plate extraction. Postoperative follow-up at 26 months demonstrated complete bony union, resolved infection, and restored ambulatory capacity, with minor limitations in knee/ankle range of motion. Conclusion This case validates the efficacy of a staged, multidisciplinary approach. It combines aggressive infection control (antibiotic cement spacers and serial debridement) with bone transport techniques for limb salvage in complex crush injuries. The protocol achieved synchronous soft tissue repair and segmental defect reconstruction. This approach emphasizes the critical role of patient compliance, dynamic mechanical stabilization, and incremental soft tissue optimization. This strategy offers a reproducible framework for managing high-energy trauma complicated byosteomyelitis and critical bone loss.

The transoral transmandibular approach is indicated for pathologies affecting C1-3 that require an anterior or combined anteroposterior approach to address. This approach has been described previously for cervical tumors requiring en bloc resection, deformity, and pathologic fractures secondary to rheumatological disease. Here, we to illustrate the transoral transmandibular approach for cervical osteomyelitis. A 29-year-old male presented with neck pain and was found to have osteomyelitis of unclear etiology at C1-4 complicated by pathological fractures at C2-3. He initially underwent a C1-5 posterior spinal fusion and empiric antibiotic therapy but represented 3 months later with pseudoarthrosis. Due to posterior element erosion, the patient underwent an anterior transoral transmandibular approach for C2-4 corpectomies and C1-5 anterior fusion, followed by posterior occiput-C6 fusion. Postoperatively stable neurological exam and improved neck pain. This case demonstrates how the anterior transoral transmandibular approach enables access and robust multilevel anterior column reconstruction for pathologies affecting C1-3.

IntroductionSeptic arthritis of the hip can appear isolated or concomitant with pelvic osteomyelitis. Delay in the diagnosis of a concomitant osteomyelitis increases the number of required surgeries and of possible complications.PurposeThis study aims to establish relevant factors in the diagnosis of concomitant osteomyelitis in cases with septic arthritis of the hip among paediatric patients.MethodsThe data were collected between 2005 and 2020. 41 pediatric patients with suspicion of septic arthritis of the hip joint, treated arthroscopically, were included. The following diagnostic test parameters were collected: ultrasound, MRI, X-Rays, blood samples, temperature, and incapacity to bear weight. The data were analysed with the sensitive analysis method using descriptive statistic.Results41 patients were analyzed, with an average age of 6.04 y (7 months to 14 years), of which ten patients (24.39%) presented concomitant osteomyelitis. 6 out of ten patients needed secondary surgery. Regarding age, concomitant osteomyelitis was most common in the age group 4–14 years old. Average number of days of clinical symptoms before admission was 6.2 days. 36/41 cases showed CRP values higher than 2 mg/dl. 9/10 cases with concomitant osteomyelitis showed a CRP > 2 mg/dl, with an average value of 8.9 mg/dl. 22/41 patients underwent an MRI, of which nine cases presented a concomitant osteomyelitis.The probability of a child to have septic arthritis of the hip with adjacent osteomyelitis was analysed through a score based on four factors: impossibility to bear weight and/or hip pain in children in the non-walking age category, CRP > 2 mg/dl, age older than > 4 y, symptoms longer than 4 days.ConclusionsChildren at the age of walking, with incapacity to bear weight, presenting symptoms longer than 4 days and a CRP > 2 mg/dl, should receive an MRI before surgery to exclude adjacent osteomyelitis.Level of evidenceIV.