Pathophysiology of posttraumatic osteomyelitis

Understanding the pathophysiology of posttraumatic osteomyelitis is crucial as researchers attempt to meet the challenge of developing more effective strategies for the management and prevention of this infection. Some aspect s of pathogenesis have been well described, including the important roles o f the extent of soft tissue injury, bacterial attachment to necrotic bone a nd fixation devices, and bacterial contamination at the time of injury. Mor e recently, the importance of early wound coverage in preventing osteomyeli tis has been emphasized. Now some of the cellular interactions that promote infection and tissue damage are beginning to be understood. Trauma can hav e deleterious effects on host response to infection through its activation of certain cytokines. These cytokines, mainly produced by cells of the immu ne system, regulate the action of polymorphonuclear leukocytes, macrophages , and lymphocytes. Bacteria have been shown to use diverse tactics to initi ate and maintain infection that lead to host defense impairment, decreased efficacy of antibiotics, and direct tissue damage, New insights into the pa thophysiology of osteomyelitis may lead to the innovative therapeutic appro aches needed to improve the standard of care for this infection.