Indications
- Chronic osteomyelitis with sequestrum, sinus or failed antibiotics
- Infected nonunion and fracture related infection
- Septic arthritis complicating adjacent osteomyelitis
- Diabetic foot osteomyelitis not responding to antibiotics
Position
- Depends on site, tourniquet without exsanguination
Operative Steps
- Stage with Cierny Mader host and anatomical type
- MRI and CT to map sequestrum and extent
- Excise sinus tracts and remove implants
- Debride to bleeding bone, the paprika sign
- Take at least five deep samples with separate instruments
- Manage dead space with antibiotic loaded carriers or a cement spacer
- Stabilise bone and obtain soft tissue cover
- Masquelet induced membrane technique for segmental defects
- Stop antibiotics about 2 weeks before surgery where safe, to improve culture yield
- Send samples for histology as well as culture
- Ilizarov bone transport for larger defects
Postoperative Care
- Targeted antibiotics with infectious diseases input
- Monitor CRP and wound
- Antibiotics usually for about 6 weeks, with early oral switch (OVIVA trial)
- Protected weight bearing until bone is strong
- Long term follow up for recurrence, which can occur years later
Complications
- Recurrence
- Fracture through weakened bone
- Wound breakdown
- Squamous cell carcinoma in long standing sinus (Marjolin ulcer)
- Amputation after repeated failure
- Leg length discrepancy and deformity
- Nonunion after resection of infected bone
Related Pages
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.