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Invited Commentary

  • Bradford Henley


Dr. Goris has provided a succinct review of bone and joint infections related to trauma and surgery. This contribution begins with definitions. Though hematogenous osteomyelitis is differentiated from osteitis, these conditions are quite similar in their histopathology in that both exhibit an inflammatory process involving bone. Perhaps it is useful to differentiate them by their osseous location, as this distinction may aid in one's treatment decisions. Goris suggests that osteomyelitis be thought of as an infection of metaphyseal (trabecular and richly vascular) bone, usually occurring in juvenile patients. Morrisey and others [1, 2] have demonstrated that bacteria have a predilection to infect metaphyseal regions after trauma. On the other hand, Goris suggests that osteitis be considered an infection of cortical (haversian and less well vascularized) bone, primarily in adults. He infers that osteitis is most commonly seen in the posttraumatic and postsurgical clinical settings due to direct inoculation in contrast to hematogenous spread. The implication is that metaphyseal osteomyelitis infections, especially in juveniles, may be treated by antibiotic therapy alone, but in the presence of a medullary abscess (or dead bone) surgical drainage may be indicated. In contrast, to heal cortical posttraumatic osteitis infections, surgical debridement and/or resorption of dead bone (sequestra) with concomitant adjunctive antibiotics is usually required.


Septic Arthritis Joint Infection Surgical Debridement Musculoskeletal Infection Subacute Bacterial Endocarditis 
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  1. 1.
    Morrissy RT, Haynes DW, Nelson CL (1980) Acute hematogenous osteomyelitis: the role of trauma in a reproducible model. Trans Orthop Res Soc 5:324Google Scholar
  2. 2.
    Whalen JL, Fitzgerald RH Jr, Morrissy RT (1988) A histological study of acute hematogenous osteomyelitis following physeal injuries in rabbits. J Bone Joint Surg 70A:1383–1392Google Scholar
  3. 3.
    Cierny G III, Mader JT, Penninck JJ (1985) A clinical staging system for adult osteomyelitis. Contemp Orthop 10:17–37Google Scholar

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© Springer-Verlag Berlin Heidelberg 2003

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  • Bradford Henley

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