SUBACUTE HEMATOGENOUS OSTEOMYELITIS - ARE BIOPSY AND SURGERY ALWAYS INDICATED

Forty-four consecutive cases of subacute osteomyelitis admitted at our institution over a 12-year period were retrospectively reviewed to as sess the effectiveness of conservative versus surgical treatment of th is condition and to determine the indications for open biopsy and surg ical debridement. Twenty-four cases were treated with antibiotics only , and 20 had surgical debridement followed by antibiotics. Except for one case that received inadequate antibiotic therapy, all patients res ponded well to this treatment, whether conservative or surgical. At an average follow-up of 18 months, there were no recurrences. Our result s also showed that with a careful radiologic assessment of these cases , most lesions showed characteristic benign radiologic features. We ca n therefore conclude that conservative management of cases of subacute osteomyelitis is as effective as surgical treatment. We believe that conservative treatment with antibiotics should be the first line of ma nagement in most of these cases and that open biopsy or surgical debri dement or both should be reserved for cases that do not respond to ant ibiotics or show aggressive radiologic features.