Table 1.

Treatment modalities for different types of osteomyelitis.

Anatomic type	Description	Treatment
I. Medullary	Endosteal nidus: Infection is confined to medullary space; treatment likely does not require bone grafting.	Small unroofing of cortex, curettage of medullary space, medullary reaming
II. Superficial	Bone surface nidus: Infection is confined to outer surface of bone with soft tissue compromise. Treatment will not destabilize bone and thus will not require hardware fixation.	Superficial decortication Soft tissue coverage - Pedicle tissue flap - Free tissue flap
III. Localized	Localized bone necrosis: Focalized sequestration of cortical bone. Excision may require fixation if there is a destabilized bone structure.	Sequestrectomy, medullary decompression, scar excision, superficial decortication, stabilization if necessary
IV. Diffuse	Extensive bone destruction: Involvement of permeated destruction of cortical bone causes unstable bone structure.	Stabilization and soft tissue coverage are required; external fixation is the safest and most versatile technique.
All four types of osteomyelitis require antibiotic coverage systemically with possible adjuvant local treatment:
- Antibiotic laden beads.
- Antibiotic cement spacers.
- Antibiotic intramedulllary nail.
- Local antibiotic powders.