[Therapeutic management of fracture-induced osteitis]

Fractural osteitis is considered to be exclusively of external origin, being due either to accidental wounds, or to operatory wounds. The infection is usually either with a single strain of germs, or with a small number of strains, most frequently a staphylococcus strain with a necrototizing effect on the bone structure. The prophylaxis has a determinant role, and the authors stress the organisatory measures, as well as the medical attitudes that should prevail in the face of an open fracture. In the case of closed fractures that have been infected as a result of surgery the necessity for an "early reintervention" is stressed. Late postoperative osteitis may develop in a consolidated focus, and is called osteitis of the repaired bone. It may also develop as an osteoarthritis or, and this is more serious, as a suppurated pseudarthrosis. The therapeutic attitude depends on the condition, and may consist in the removal of the osteosynthesis material, removal of the sequestered bone tissue, a so-called: "mis-à-plat" of the cavity with muscular tissue and application of septopal pearls, or a two-stage spongious graft according to Papineau, under protection of the external fixation when the necessity arises.