Abstract CHRONIC traumatic osteomyelitis following injuries of long bones sustained in World War II was one of the most serious problems confronting the army general hospital one year after the cessation of hostilities. At Oliver General Hospital over 300 patients with chronic osteomyelitis were treated from Oct. 1, 1946 to Jan. 1, 1948. Various principles of conservative and surgical management1 evolved from World War I to the present were applied, with uniformly good results.2 However, in spite of diligent measures, infection persisted in certain refractory cases. In the present study of 26 such cases, all cases of united fractures, we sought to evaluate the effectiveness of streptomycin with or without the combination of penicillin.3 Four cases of infection following bone graft and 1 case of chronic hematogenous osteomyelitis were also added. In this series, the average duration of infection was 26.2 months and an average of 3.6 sequestrectomies References 1. Orr, H. W.: The Treatment of Infected Wounds Without Sutures, Drainage Tubes, or Antiseptic Dressings , J. Bone & Joint Surg. 10:605-611, 1928 2. The Development of the Concept of Antisepsis and Asepsis from Lister to World War II , Surg., Gynec. and Obst. 85:209-224, 1947. 3. Trueta, J.: The Treatment of War Wounds and Fractures , New York, Paul B. Hoeber, Inc. 4. Kelly, R. P.; Rosati, L. M., and Murry, R. A.: Traumatic Osteomyelitis: The Use of Skin Grafts; I. Technic and Results , Ann. Surg. 122:1-11, 1945 5. Traumatic Osteomyelitis: The Use of Skin Grafts; I. Technic and Results , Murry Ann. Surg. 122:1-11, 1945 6. Traumatic Osteomyelitis: The Use of Skin Grafts; II. Subsequent Treatment , Murry Ann. Surg. 123:688-697, 1946. 7. Churchill, E. D.: The Surgical Management of the Wounded in the Mediterranean Theater at the Time of the Fall of Rome , Ann. Surg. 120:268-283, 1944. 8. Dehne, E.; Smith, W. S., and Ganey, J. B.: Unpublished Data. 9. Lockwood, J. S.: White, W. L., and Murphy, F. D.: The Use of Penicillin in Surgical Infections , Ann. Surg. 120:311-344, 1944. 10. Lyons, C.: Penicillin Therapy of Surgical Infections in the United States Army , J. A. M. A. 123:1007-1018 ( (Dec. 18) ) 1943. 11. Meleney, F. L.: The Difficulty of Evaluating Drug Treatment in Surgical Infections , J. A. M. A. 124:1021-1026 ( (April 8) ) 1944. 12. Lemphier, T. A., and Cashman, C.: Treatment of Chronic Osteomyelitis with Streptomycin , New England J. Med. 236:318-322, 1947. 13. DeBakey, M., and Pulaski, E. J.: An Analysis of the Experience with Streptomycin in the United States Army Hospitals , Surgery 20:749-761, 1946. 14. Howes, E. L.: Topical Use of Streptomycin in Wounds , Am. J. Med. 2:449-456, 1947. 15. (a) Abraham, E. P., and Chain, E.: An Enzyme from Bacteria Able to Destroy Penicillin , Nature, London 146:837, 1940. 16. (b) McQuarrie, E. B., and Liebmann, J.: Studies on Penicillinase , Arch. Biochem. 5:301-315, 1944. 17. Pulaski, E. J.: Streptomycin: Status Report on Its Therapeutic Use , Bull. U. S. Army M. Dept. 6:565-570, 1946. 18. Florey, M. E.; Ross, R. W. N. L., and Thornton, E. E.: Infection of Wounds with Gram Negative Organisms: Clinical Manifestations and Treatment , Lancet 1:855-861, 1947. 19. Howes.7 Florey, Ross and Thornton.10 20. Pulaski, E. J.: Streptomycin Therapy , Bull. U. S. Army M. Dept. 7:739, 1947. 21. Carrel, A., and Dehelly, G.: Infected Wounds , New York, Paul B. Hoeber, Inc., 1917. 22. Nichols, D. R., and Herrell, W. E.: Streptomycin: Its Clinical Uses and Limitations , J. A. M. A. 132:200-205 ( (Sept. 28) ) 1946. 23. Buggs, C. W.; Bronstein, B.; Hirschfeld, J. W., and Pilling, M. A.: In Vitro Action of Streptomycin on Bacteria , J. A. M. A. 130:64-67 ( (Jan. 12) ) 1946. 24. Finland, M.; Murray, R.; Harris, H. W.; Kilham, C., and Meads, M.: Development of Streptomycin Resistence During Treatment , J. A. M. A. 132:16-21 ( (Sept. 7) ) 1946. 25. Topley, W. W. C., and Wilson, G. S.: The Principles of Bacteriology and Immunity: Local Immunity , Baltimore, Williams & Wilkens Company, 1936, chap. 50 , pp. 924-931. 26. The anatomic considerations are to be presented in another paper from the Orthopaedic Section, Oliver General Hospital. 27. Pulaski, E. J.: Collective Review: Antisepsis and Disinfection in Surgery , Internat. Abstr. Surg. 84:107-121, 1947.
Archives of Surgery – American Medical Association
Published: Jan 1, 1950