This 2004 Lancet seminar by Lew and Waldvogel surveys the pathophysiology, diagnosis, and treatment of osteomyelitis across its three principal types—contiguous-focus, vascular insufficiency, and haematogenous—asking why bone infections remain so difficult to cure despite modern antimicrobials and what strategies actually work.
When you encounter a diabetic foot wound probing to bone, suspect osteomyelitis and obtain a bone biopsy — sinus-tract swabs are unreliable and will mislead your antibiotic choice.
For chronic osteomyelitis with sequestrum on imaging, plan for surgical debridement from the outset; antibiotics alone will not achieve cure, and inadequate debridement is a leading driver of recurrence.
This 2004 Lancet seminar by Lew and Waldvogel surveys the pathophysiology, diagnosis, and treatment of osteomyelitis across its three principal types—contiguous-focus, vascular insufficiency, and haematogenous—asking why bone infections remain so difficult to cure despite modern antimicrobials and what strategies actually work.
When you encounter a diabetic foot wound probing to bone, suspect osteomyelitis and obtain a bone biopsy — sinus-tract swabs are unreliable and will mislead your antibiotic choice.
For chronic osteomyelitis with sequestrum on imaging, plan for surgical debridement from the outset; antibiotics alone will not achieve cure, and inadequate debridement is a leading driver of recurrence.