Osteomyelitis is an infection-related inflammatory disease of the bones. Imaging and laboratory results are typically used to support a clinical diagnosis of osteomyelitis. Microbial cultures and bone biopsies provide conclusive diagnoses. The first imaging procedure that needs to be done is radiography, but its sensitivity is low in the early stages of the disease. The sensitivity of magnetic resonance imaging, both with and without contrast material, is higher for detecting areas of bone necrosis in advanced stages. Patients can be categorised for surgical treatment using a staging system based on major and minor risk factors. The main course of treatment should be antibiotics, which should be chosen depending on the findings of the culture and the characteristics of each patient. Bony debridement surgery is frequently required, and in high-risk patients or those with severe illness, additional surgical intervention can be necessary. Better outcomes are being attained in the treatment of this illness thanks to advancements in surgical treatment, antibiotic therapy, and the current resources for precise diagnosis and tailored responses to each kind of osteomyelitis.

The classification systems that are most frequently employed, as well as the general epidemiological ideas, are presented together with the discussion of acute and chronic osteomyelitis.

The key recommendations for diagnosing infections clinically, in the laboratory, and through imaging are covered, along with the recommendations for surgical and antibiotic procedures, and the function of hyperbaric oxygen as adjuvant therapy.

We evaluate the osteomyelitis-related articles, summarise the most recent developments in diagnostic procedures and therapeutic regimens, evaluate the benefits and drawbacks of various diagnostic modalities and therapeutic approaches, and suggest areas of focus to help current diagnostic and therapeutic approaches.

Treatment

The main course of treatment should be antibiotics, which should be chosen depending on the findings of the culture and the characteristics of each patient [1]. Orthopedic physicians and patients have new treatment options with cutting-edge reconstruction and repair techniques like Ilizarov and Orthofix LRS. Surgery used to try to remove infected and necrotic bone worsens the patient’s condition [2]. As a result of new biomaterials entering the market, such as bioactive glass S53P4 (BonAlive®, Bonalive Biomaterials Ltd., Turku, Finland) and CeramentTM G (Bonesupport, Lund, Sweden), osteomyelitis therapy is gradually moving from a two-stage to a one-stage approach in the Western world [14]. If an imaging examination reveals osteomyelitis, then start antibiotics right away. If the patient has unstable hemodynamics, then hold off on antibiotics until after the biopsy of the patient is hemodynamically stable, unless the blood cultures are positive. Consider consulting a neurosurgeon and every four hours, conduct a neurological examination. If the patient’s hemodynamics are stable and no encouraging microbiological or imaging results are found, then keep other diagnoses in mind and repeat imaging in 1-3 weeks if discomfort is persistent.

Medical treatment entails correcting any host inadequacies, choosing an initial antibiotic, and modifying that antibiotic based on culture results. Effective oral drugs and local therapy using antibiotics combined with polymethylmethacrylate have both been added to the repertoire of antibiotic delivery methods [15]. The selection of antibiotics is complicated by the rise of methicillin-resistant Staphylococcus aureus (S. aureus) osteomyelitis. In chronic situations, surgical debridement is typically required. Even after surgical intervention and prolonged antibiotic medication, the recurrence rate is still significant. A four-week course of antibiotics is often effective in treating acute hematogenous osteomyelitis in children [16]. Bacteremic bone seeding causes acute hematogenous osteomyelitis. Because the metaphyseal (developing) portions of the long bones are extremely vascular and sensitive to even slight damage, children are most frequently impacted. Acute hematogenous osteomyelitis affects children under the age of five in more than half of cases [16]. Treatment with antibiotics can be given intravenously or orally [17]. The best type, method of administration, and length of antibiotic therapy are still debatable, and the rise of multi-drug resistance pathogens presents significant therapeutic difficulties. The fate of patients is significantly influenced by the determination of the underlying cause and subsequent targeted antibiotic therapy [18].

To get high doses of the medication into the blood, antibiotics are typically administered initially by IV. In the future, antibiotic pills might be taken. Antibiotics are typically required for four weeks for children. Antibiotics must be taken for six to eight weeks by adults [19]. The therapy of osteomyelitis was well-reviewed by Drs. Hatzenbuehler and Pulling.

One crucial tool, which is useful for chronic diseases was left out. In patients with persistent refractory osteomyelitis, hyperbaric oxygen treatment (HBOT) is linked to remission rates of 81% to 85% at two to three years. It entails putting the patient in a single or multiple-person chamber where he or she is exposed to higher atmospheric pressure while breathing only 100% oxygen. A typical therapy course consists of five 90-minute sessions over the course of 20 to 60 sessions. Enhanced leukocyte oxidative killing, osteogenesis, angiogenesis, and synergistic antibiotic activity are the mechanisms of action. Treatment complications are rare, and pneumothorax and prior bleomycin therapy are the only absolute contraindications. Local hyperbaric resources should be known to family doctors, who should consider using this treatment for the right patients [20]. Before attempting more extensive surgical treatments, culture-directed antibiotics and HBO2 therapy offer a reasonable chance of curing osteomyelitis. In general, HBO2 therapy is administered once per day, five to seven days a week, for 90 to 120 minutes, at 2.0 to 3.0 atmospheres absolute (ATA) pressure. The current antibiotic and HBO2 therapy regimen should be continued in cases where rapid clinical improvement is observed for a period of four to six weeks; 20-40 HBO2 treatments are often needed to produce long-lasting therapeutic benefits [21].

Conclusions