Watson F M, Whitesides T E
Clin Orthop Relat Res. 1976 Jun(117):296-302.
Five cases of acute hematogenous osteomyelitis occurring at the site of closed fractures are reported. This is a serious and potentially lethal complication resulting in directly in the death of 3 of the 5 patients. This is an unusual occurrence seen infrequently, and subsequent delay in diagnosis is frequent. An awareness of this complication (which usually occurs in the face of decreased resistance to infection) coupled with careful inspection of the fracture site, evaluation of the patient as a whole, and a high index of suspicion will allow earlier diagnosis and possibly more successful early treatment. Because of the pathophysiology of this lesion and the usual delay in diagnosis, initial treatment should include wide surgical drainage of the abscess with proper debridement and bony resection. This may involve procedures which at first glance may appear to be mutilating. In these patients with decreased resistance to infection, the initial appropriate choice of antibiotics is essential.
报告了5例发生于闭合性骨折部位的急性血源性骨髓炎病例。这是一种严重且可能致命的并发症，直接导致了5例患者中的3例死亡。这是一种罕见的情况，随后诊断延迟很常见。认识到这种并发症（通常发生在抗感染能力下降的情况下），并仔细检查骨折部位、全面评估患者，保持高度怀疑指数，将有助于早期诊断，并可能使早期治疗更成功。由于这种病变的病理生理学特点以及通常的诊断延迟，初始治疗应包括对脓肿进行广泛的手术引流，并进行适当的清创和骨切除。这可能涉及乍一看似乎是致残性的手术。对于这些抗感染能力下降的患者，初始合理选择抗生素至关重要。
