Skip to main content

Advertisement

SpringerLink
Log in

Postoperative und bakterielle Osteitis

Neue Therapieansätze

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die posttraumatische Osteitis bedeutet chronische Osteitis von Beginn an. Die wesentlichen Therapien dieser Komplikation sind das Débridement mit Gewebekonditionierung und Stabilisierung sowie die Behandlung der Weichteile mit Lappenplastiken. So werden die Langzeitresultate deutlich verbessert. Doch meist ist die Behandlung langdauernd—mit allen körperlichen, seelischen und sozialen Folgen für den Patienten und finanziellen für die Kostenträger behaftet. Die medikamentöse, adjuvante Therapie ist auch weiterhin Standard. Zunehmende Resistenzen, weltweit nachweisbar, erschweren die Behandlung. Daher sind alternative Therapien zu überdenken und neue Ansätze auf Wirksamkeit zu prüfen. Die Entstehung der Osteitis im Ansatz zu verhindern oder den Verlauf zu verkürzen, ist das Ziel. Die immunologischen Veränderungen bei der Osteitis in ihrer Gesamtheit sind jedoch noch nicht bekannt, zumal sich die nahezu ausschließlich tierexperimentellen Arbeiten nur unzureichend auf den Menschen übertragen lassen.

Abstract

Current therapy concepts for post-trauma osteitis include radical debridement, stabilization of bone and soft tissue care using early flap transfers. With this more radical approach, the long term results are improved, however, total treatment time still is very long. In addition to the physical, mental and social consequences for the patient, treatment costs are also very high. Antibiotic therapy as an adjuvant is still standard and effective although the development of worldwide antibiotic resistance has increased treatment difficulties. One of the main aims of research is to reduce these problems or to prevent the development of osteitis entirely. However, research has not yet elucidated the complex immunologic changes involved. In addition, most results are obtained from animal studies and clinical investigations are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M (1996) Influence of materials for fixation implants on local infection. Experimental study of steel vs. titanium DCP in rabbits. J Bone Joint Surg Br 78 (4): 647–651

    Google Scholar 

  2. Balaban N, Goldkorn T, Nhan RT (1998) Autoinducer of virulence as a target for vaccine and therapy against Staphylococcus aureus. Science 280: 438–440

    Article  CAS  PubMed  Google Scholar 

  3. Balaban N, Novick RP (1995) Autocrine regulation of toxin synthesis by Staphylococcus aureus. Proc Natl Acad Sci 92: 1619

    CAS  PubMed  Google Scholar 

  4. Bansal VP, Mittal PK, Ashokraj G (1992) Humoral immune responses in osteomyelitis. Int Orthop 16: 297–301

    CAS  PubMed  Google Scholar 

  5. Bohm E, Josten C (1992) What’s new in exogenous osteomyelitis? Pathol Res Pract 188: 254–258

    CAS  PubMed  Google Scholar 

  6. Bonomo SR, Davidson JD, Yu Y, Xia Y, Lin X, Mustoe TA (1998) Hyperbaric oxygen as a signal transducer: upregukation of platelet derived growth factor-beta receptor in the presence of HBO2 and PDGF. Undersea Hyperb Med: 25: 211–216

  7. Bonomo SR, Davidson JD, Tyrone JW, Lin X, Mustoe TA (2000) Enhancement of wound healing by hyperbarich oxygen and transforming growth factor-β3 in a new chronic wound model in aged rabbits. Arch Surg 135 (10): 1148–1153

    Article  CAS  PubMed  Google Scholar 

  8. Bost KL, Ramp WK, Nicholson NC, Bento JL, Marriott I, Hudson MC (1999) Staphylococcus aureus infection of mouse or human osteoblasts induces high levels of interleukin-6 and interleukin-12 production. J Infect Dis 180: 1912–1920

    Article  CAS  PubMed  Google Scholar 

  9. Chuard C, Vaudaux P, Waldvogel FA, Lew DP(1993) Susceptibility of Staphylococcus aureus growing on fibronectin-coated surfaces to bacterial antibiotics. Antimicrob Agents Chemoth 37: 625–632

    CAS  Google Scholar 

  10. Ciampolini J, Harding KG (2000) Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often? Postgrad Med J 76: 479–483

    Article  CAS  PubMed  Google Scholar 

  11. Cierny G (1990) The classification and treatment of adult osteomyelitis. In: Evarts (ed) Surgery of the musculoskeletal systems, 2nd edn. Churchill Livingstone, New York

  12. Cierny G, Mader JT (1987) Approach to adult osteomyelitis. Orthop Rev 16: 95–106

    Google Scholar 

  13. Costerton JW, Stewart PS, Greenberg EP (1999) Bacterial Biofilms: A common cause of persistent infections. Science 284 (5418): 1318

    Article  CAS  PubMed  Google Scholar 

  14. Davies DG, Parsek MR, Pearson JP (1998) The involvement of cell-to-cell signals in the development of a bacterial biofilm. Science 280: 295–298

    CAS  PubMed  Google Scholar 

  15. Davis JC, Heckman JD, DeLee JC (1986) Chronic non-hematogemous osteomyelitis treated with adjuvant hyperbaric oxygen. J Bone Joint Surg 68A: 1210–1217

    Google Scholar 

  16. De La Mata J, Uy HL Guise TA (1995) Interleukin-6 enhances hypercalcaemia and bone resorption mediated by parathyroid hormone-related protein in vivo. J Clin Invest 95: 2846–2852

    PubMed  Google Scholar 

  17. Eerenberg JP (1996) GAK. Fractuur statisticken. In: Taurolidin in treatment of experimental post-traumatic osteomyelitis. CIP-DATA Koninklijske, Bibliotheken Den Haag

  18. Esterhai JL, Pisarello J, Brighton CT, Heppenstall RB, Gellman H, Goldstein G (1987) Adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis. J Trauma 27 (7): 763–768

    PubMed  Google Scholar 

  19. Evans RP, Nelson CL, Harrison BH (1993) The effect of wound environment on the incidence of acute osteomyelitis. Clin Orthop 286: 289–297

    PubMed  Google Scholar 

  20. Fattom AI, Naso R (1996) Staphylococcal vaccines: A realistic dream? Ann Med 28: 43–46

    CAS  PubMed  Google Scholar 

  21. Fattom A, Schneerson R, Karakawa WW (1993) Laboratory and clinical evaluation of conjugate vaccines composed of Staph. aureus types 5 and 8 capsular polysaccharides bound to Pseudomonas aeruginosa recombinant exoprotein A. Infect Immun 61: 1023–1032

    CAS  PubMed  Google Scholar 

  22. Flock JI (1999) Extracellular-matrix-binding proteins as targets for the prevention of Staphylococcus aureus infections. Mol Med Today 5(12): 532–537

    Article  CAS  PubMed  Google Scholar 

  23. Fuller K, Owens JM, Chambers TJ (1995) Macrophage inflammatory protein-1α and IL-8 stimulate the motility but suppress the resorption of isolated rat osteoclasts. J Immun 154: 6065–6072

    CAS  PubMed  Google Scholar 

  24. Fuqua C, Winans SC, Greenberg EP (1996) Census and consensus in bacterial ecosystems: the LUXR-LuxL family of quorum-sensing transscriptional regulators. Annu Rev Microbiol 50: 727–751

    Article  CAS  PubMed  Google Scholar 

  25. Gadd MA, McClellan DS, Meuman TS, Hansbrough JF (1990) Effect of hyperbaric oxygen on murine neutrophil and T-lymphmozyte functions. Crit Care Med 18 (9): 974–979

    CAS  PubMed  Google Scholar 

  26. Galán JE, Collmer A (1999) Type III secretion machines: Bacterial devices for protein delivery into host cells. Science 284 (5418): 1322–1330

    Article  PubMed  Google Scholar 

  27. Garrett IR, Boyce BF, Oreffo RO, Bonewald L, Poser J, Mundy GR (1990) Oxygen-derived free radicals stimulate osteoclastic bone resorption in rodent bone in vitro and in vivo. J Clin Invest 85 (3): 632–639

    CAS  PubMed  Google Scholar 

  28. Greenfield EM, Horowitz MC, Lavish SA (1996) Stimulation of parathyroid hormone of interleukin-6 and leukemia inhibitory factor expression in osteoblasts is an immediate-early gene response induced by cAMP signal transduction. J Biol Chem 271: 10984–10989

    Article  CAS  PubMed  Google Scholar 

  29. Gristina AG, Oga M, Webb LX, Hobgood CD (1985) Adherent bacterial colonization in the pathogenesis of osteomyelitis. Science 228: 990–993

    CAS  PubMed  Google Scholar 

  30. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of 1025 open fractures of long bones: Retrospective and prospective analysis. J Bone Joint Surg 58A: 453–458

    Google Scholar 

  31. Haas DW, McAndrew MP (1996) Bacterial osteomyelitis in adults: evolving considerations in diagnosis and treatment. Am J Med 101: 550–561

    Article  PubMed  Google Scholar 

  32. Herenberger K, Brismar K, Folke L, Kratz G (1997) Dose-dependant hyperbaric oxygen stimulation of human fibroblast proliferation. Wound Rep Reg 5: 147–150

    Google Scholar 

  33. Hoch RC, Rodriguez R, Manning T (1993) Effects of accidental trauma on cytokine and endotoxin production. Crit Care Med 21: 839–845

    CAS  PubMed  Google Scholar 

  34. Horowitz SM, Algan SA, Purdon MA (1996) Pharmacologic inhibition of particulate-induced bone resorption. J Biomed Mater Res 31: 91–96

    Google Scholar 

  35. Horowitz M, Lorenzo J (1996) Local Regulators of Bone. IL-1, TNF, and Lymphotoxin, Interferon-Gamma, IL-8, IL-10, IL-4, the LIF/IL-6 Family, and Additional Cytokines. In: Bilezikian JP, Raisz L, Rodan G (eds) Principles of bone biology. Academic Press, San Francisco, pp 687–700

  36. Karakawa WW, Fournier JM, Vann WF, Arbeit R, Schneerson R, Robbina JB (1985) Capsular antibodies induce type-specific phagozytosis of Staph. aureus by human polymorphonuclear leukocytes. Infect Immun 58: 1090–1095

    Google Scholar 

  37. Kinzl L, Suger G (1996) Infizierte Pseudarthrose. Orthopäde 25: 478–483

    Google Scholar 

  38. Lahat N, Bitterman H, Yaniv N, Kinarty A, Bitterman N (1995) Exposure to hyperbaric oxygen induces tumor necrosis factor-alpha (TNF-α) secretion from rat macrophages. Clin Exp Immunol 102: 655–659

    CAS  PubMed  Google Scholar 

  39. Lazzazzera BA, Solomon JM, Grossmann AD (1997) An exported peptide functions intracellulary to contribute to cell to cell density signaling in B. subtilis. Cell 89: 917–925

    PubMed  Google Scholar 

  40. Lee JC (1996) The prospects for developing a vaccine against Staph.aureus. Trends Microbiol 4: 162

    Article  CAS  PubMed  Google Scholar 

  41. Lee JC, Perez NE, Hopkis CA, Pier G (1988) Purified capsular polysaccharide-induced immunity to Staph.aureus infection. J Infect Dis 157: 723–730

    Google Scholar 

  42. Littlewood-Evans AJ, Hattenberger MR, Luscher A (1997) Local expression of tumor necrosis factor alpha in a experimental model of acute osteomyelitis in rats. Infect Immun 65: 3438–3443

    CAS  PubMed  Google Scholar 

  43. Mader JT, Adams KR, Sutton TE (1987) Infectious diseases: Pathophysiology and mechanisms of hyperbaric oxygen. J Hyperbaric Med 2: 133–140

    Google Scholar 

  44. Mader JT, Adams KR, Wallace WR, Calhoun JH (1990) Hyperbaric Oxygen as adjunctive therapy for osteomyelitis. Infect Dis Clin North Am Sep 4 (3): 433–440

    CAS  Google Scholar 

  45. Mader JT, Brown GL, Guckian JC (1980) A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis 142: 915–922

    Google Scholar 

  46. Mader JT, Calhoun J (1994) Long bone osteomyelitis: Diagnosis and Mangement. Hosp Pract 30: 71–86

    Google Scholar 

  47. Mader JT, Guckian JC, Glass DL (1978) Therapy with hyperbaric oxygen for experimental osteomyelitis due to Staphylococcus aureus in rabbits. J Infect Dis 138: 312–318

    Google Scholar 

  48. Mader JT, Shirtliff ME, Bergquist SC, Calhoun J (1999) Antimicrobial treatment of chronic osteomyelitis. Clin Orthop 360: 47–52

    Article  PubMed  Google Scholar 

  49. Marrie TJ, Costerton JW (1985) Mode of growth of bacterial pathogens in chronic polymicrobial human osteomyelitis. J Clin Microbiol 22: 924–933

    CAS  PubMed  Google Scholar 

  50. McKenney D, Pouliot KL, Wang Y et al. (1999) Broadly protective vaccine for staphylococcus aureus based on an in vivo-expressed antigen. Science 284: 1523–1527

    CAS  PubMed  Google Scholar 

  51. McKenney D, Pouliot K, Wang Y et al. (2000) Vaccine potential of poly-1-6 beta-D-N-succinylglucosamine, an immunoprotective surface polysaccharide of Staphylococcus aureus and Staphylococcus epidermidis. J Biotechnol 83 (1–2): 37–44

    Google Scholar 

  52. Mehm WJ, Pimsler M, Anderson LH (1991) Effects of hypoxia on phagocytic and adherence functions in splenic macrophages. J Hyperbar Med 6: 33–42

    Google Scholar 

  53. Mendel V, Reichert B, Simanowski HU, Scholz HC (1999) Therapy with hyperbaric oxygen and cefazolin for experimental osteomyelitis due to Staphylococcus aureus in rats. Undersea Hyperbar Med 26: 169–174

    CAS  Google Scholar 

  54. Miossec P, Chomarat P, Dechanet J (1994) Interleukin-4 inhibits bone resorption through an effect on osteoclasts and proinflammatory cytokines in an ex vivo model of bone resorption in rheumatoid arthritis. Arthritis Rheum 12: 1715–11722

    Google Scholar 

  55. Morrey BF, Dunn JM, Heimbach RD (1979) Hyperbaric oxygen and chronic osteomyelitis. Clin Orthop 144: 121–127

    PubMed  Google Scholar 

  56. Mutschler W (2001) Hyperbare Sauerstofftherapie in der Unfallchirurgie. Unfallchirurg 104: 101–114

    Article  CAS  PubMed  Google Scholar 

  57. Naylor PT, Myrvik QN, Gristina A (1990) Antibiotic resistance of biomaterial-adherent coagulase- negative and coagulase-positive staphylococci. Clin Orthop 261: 126–133

    PubMed  Google Scholar 

  58. Noble WC, Virani Z, Cree RGA (1992) Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staph.aureus. FEMS Microbiol Lett 93: 195–198

    Article  CAS  Google Scholar 

  59. Nylander G, Lewis D, Nordström H, Larsson J (1985) Reduction of postischemic edema with hyperbaric oxygen. Plast Reconstruct Surg 176: 596–601

    Google Scholar 

  60. O’Keefe RJ, Teot LA, Singh D, Puzas JE, Rosier RN, Hicks DG (1997) Osteoclasts constitutively express regulators of bone resorption: an immunohistochemical and in situ hybridization study. Lab Invest 76: 457–465

    CAS  PubMed  Google Scholar 

  61. Park MK, Muhvich KH, Myers RAM, Marzella L (1991) Hyperoxia prolongs the aminoglycoside-induced postantibiotic effect in pseudomonas aeruginosa. Antimicrob Agents Chemother 35: 691–695

    CAS  PubMed  Google Scholar 

  62. Pesanti EL, Lorenzo JA (1998) Osteoclasts and Effects of Interleukin 4 in Development of Chronic Osteomyelitis. Clin Orthop 355: 290–299

    Article  PubMed  Google Scholar 

  63. Peters KM, Koberg K, Rosendahl T, Schmutzler W, Zwadlo-Klarwasser G (1995) Alteration in the pattern of macrophage subtypes in chronic osteomyelitis compared with acute joint infection. Int Orthop 19: 162–166

    CAS  PubMed  Google Scholar 

  64. Petzold T, Feindt PR, Carl UM, Gams E (1999) Hyperbaric Oxygen Therapy in deep sternal wound infection after heart transplantation. Chest 115: 1455–1458

    Article  CAS  PubMed  Google Scholar 

  65. Proctor RA (1990) Fibronectin-staphylococcal interactions in endovascular infection. Zentralbl Bakteriol 274: 342–349

    CAS  PubMed  Google Scholar 

  66. Puzas JE, Hicks DG, Reynolds SD, O’Keefe RJ (1994) Regulation of osteoclastic activity in infection. Methods Enzymol 236: 47–58

    CAS  PubMed  Google Scholar 

  67. Rappuoli R, Scarlato V, Arico B, Balaban N (1995) In: Rappuoli R, Scarlato V, Arico B (eds) Signal transduction and bacterial virulence. Springer, Berlin Heidelberg New York Tokio, pp 1–4

  68. Schreiner A, Tonjum S, Digranes A (1974) Hyperbaric oxygen therapy in bacteroides infections. Acta Chir Scand 140: 73–76

    CAS  PubMed  Google Scholar 

  69. Simons RK, Hoyt DB (1994) Immunomodulation. In: Maull KI (ed) Advances in trauma and critical care, vol 9. CV Mosby, St. Louis, pp 135–157

  70. Smeltzer MS, Gillaspy AF (2000) Molecular pathogenesis of staphylococcal osteomyelitis. Poult Sci 79 (7): 1042–1049

    CAS  PubMed  Google Scholar 

  71. Stewart PS (1994) Biofilm accumulation model that predicts antibiotic resistance of Pseudomonas aeruginosa biofilms. Antimicrob Agents Chemother 38: 1052–1058

    CAS  PubMed  Google Scholar 

  72. Suda T, Takahashi N, Martin TJ (1992) Modulation of osteoclast differentiation. Endocr Rev 13: 66–80

    PubMed  Google Scholar 

  73. Swift S, Bainton JN, Winson MK (1994) Gram-negative bacterial communication by N-acyl homoserine lactones: a universal language? Trends Microbiol 2: 193

    Article  CAS  PubMed  Google Scholar 

  74. Tenover FC, Lancaster MV, Hill BC et al. (1998) Characterization of staphylococci with reduced susceptibilities to vancomycin and other glycopeptides. J Clin Microbiol 36 (4): 1020–1027

    CAS  PubMed  Google Scholar 

  75. Tetzloff TR, McCracken GH, Nelson FD (1978) Oral antibiotic therapy for skeletal infections in children.II.Therapy of osteomyelitis and suppurative arthritis. J Pediatr 92: 485–490

    PubMed  Google Scholar 

  76. Tsukayama T (1999) Pathophysilogy of posttraumatic osteomyelitis. Clin Orthop 360: 22–29

    Article  PubMed  Google Scholar 

  77. Tsukayama DT, Gustilo RB (1990) Antibiotic management of open fractures. In: Greene WB (ed) Instructional Course lectures, vol 39. American Academy of Orthopaedic Surgeons, Park Ridge/IL, pp 487–490

  78. Tucker KA, Reilly SS, Leslie CS, Hudson MC (2000) Intracellular Staphylococcus aureus induces apoptosis in mouse osteoblasts. FEMS Microbiol Lett 186: 151–156

    Article  CAS  PubMed  Google Scholar 

  79. Van Gijsegem F, Genin S, Boucher C (1993) Conservation of secretion pathways for pathogenicity determinants of plant and animal bacteria. Trends Microbiol 1 (5): 175–180

    Article  PubMed  Google Scholar 

  80. Verdreng M, Tarkowski A (1997) Role of neutrophils in experimental septicemia and septic arthritis induced by Staphylococcus aureus. Infect Immun 65: 2517–2521

    PubMed  Google Scholar 

  81. von Eiff C, Bettin D, Proctor RA, (1997) Recovery of small colony variants of Staphylococcus aureus following gentamycin bead placement for osteomyelitis. Clin Inf Dis 25: 1250–1251

    Google Scholar 

  82. Zamboni WA, Roth AC, Russell RC, Graham B, Suchy H, Kuchan JO (1992) Morphologic analysis of the microcirculation during reperfusion of ischemic sceletal muscle and the effect of hyperbaric oxygen. Plast Reconstruct Surg 91: 1110–1113

    Google Scholar 

  83. Severin A, Tabei K, Tenover F, Chung M, Clarke N, Tomascz A (2004) High level oxacillin and vancomycin resistance and altered cell wall composition in Staphylococcus aureus carrying the staphylococcal mecA and the enterococcal vanA gene complex. J Biol Chem 279: 3398–3407

    Article  PubMed  Google Scholar 

  84. Staphylococcus aureus with Reduced Susceptibility to Vancomycin – United States (1997) http://www.cdc.gov/mmwr/preview/mmwrhtml/00049042.htm

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie der Berufsgenossenschaftlichen Unfallklinik Ludwigshafen, Unfallchirurgische Klinik der Universität Heidelberg

    V. Heppert, U. Glatzel & A. Wentzensen

  2. Sektion Posttraumatische Osteitis der BG Unfallklinik Ludwigshafen, Ludwig-Guttmannstraße 13, 67071, Ludwigshafen

    V. Heppert

Authors
  1. V. Heppert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Glatzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Wentzensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Heppert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heppert, V., Glatzel, U. & Wentzensen, A. Postoperative und bakterielle Osteitis. Orthopäde 33, 316–326 (2004). https://doi.org/10.1007/s00132-003-0607-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-003-0607-y

Schlüsselwörter

Keywords

Search

Navigation