Acute hematogenous staphylococcal osteomyelitis: the effects of surgical drilling and curettage in an animal model.

Surgical drilling and curettage of metaphyseal medullary bone were performed in chickens 4, 8 and 15 d after bacterial inoculation with Staphylococcus aureus producing osteomyelitis. Intramedullary drilling and curettage resulted in extensive vascular damage and necrosis of medullary bone but failed to remove all viable bacteria. An effective continuing drainage channel for the pus was not established due to the formation of blood clot within the drill hole. Surgery performed before the formation of a sequestrum resulted in further spread of bacteria within the medullary cavity and the formation of a larger sequestrum than that commonly observed in the bones of infected, untreated chickens. Surgery performed after the formation of a sequestrum destroyed the abscess wall thus disrupting a natural defence mechanism of the host. Whilst a direct comparison of surgical drilling in human osteomyelitis and in this avian model cannot be made, the results suggest that production of an artificial drill hole across the cortex and curettage of the bone in human osteomyelitis would be destructive and may not be warranted.