Anaerobic osteomyelitis of long bones

Nine cases of anaerobic osteomyelitis of long bones are reviewed, and data are tabulated for an additional 52 cases from the literature. Three major clinical presentations of this disease entity include an acute hematogenous form usually involving previously normal bones in younger patients; a chronic infection in which the anaerobic bacteria superinfect a fracture site already compromised by osteomyelitis due to aerobic organisms, usually Staphylococcus aureus; and an indolent infection at the site of indwelling prosthetic devices. This last form appears to be initiated at the time of surgery by the introduction of normal cutaneous anaerobic flora into the wound, but disease does not become apparent until months to years later. The responsible organisms, pathophysiology, and clinical presentations of these three forms are discussed; and the therapeutic necessity to remove all devitalized tissues, reestablish vascularity, graft bony defects, and combine this with long-term antibiotic therapy, preferably bactericidal against the causative organisms, is emphasized.