[Hematogenous osteomyelitis of the femur in elderly patients--special forms of pathogenesis]

We present two cases of hematogenous osteomyelitis of the femur in patients who have undergone vascular surgery. We describe the course of disease, the diagnostic considerations and the therapeutic measures. Typical is the painfullness without recognizing the cause during the first days, more or less signs of inflammation of the organism, elevation of ESR. Only with distinct delay there are local signs of inflammation. Not before ten days the normal x-ray shows periosteal reactions and areas of lysis, sooner you can find indications in the CT scan (gas, changed density). After combined antibiotic and surgical treatment one case is healed, in the other occurs spontaneous fracture and amputation, and because of relapse in the stump exarticulation. In the latter case, one of the essential factors for the poor outcome is the low blood perfusion of patients with vascular disease.