Osteomyelitis and Infected Nonunion in Delhi
Osteomyelitis and Infected Nonunion in Delhi requires a systematic, staged approach: aggressive debridement, deep cultures and targeted antibiotics, stable fixation, and biologic reconstruction to eradicate infection and heal bone. Dr. Neelabh’s protocol prioritises soft‑tissue safety, dead‑space management, local antibiotic delivery, and a clear plan for union and function. We do not provide in‑house physiotherapy; we share written protocols and coordinate with your physiotherapist for phased recovery.
Debridement • Local antibiotics • Stable reconstruction • Close follow‑up
About Osteomyelitis & Infected Nonunion
Osteomyelitis is bone infection—sometimes following open fractures, prior surgery, or bloodstream spread. Infected nonunion occurs when a fracture fails to heal and becomes infected, often due to instability, dead bone, or contamination. These conditions demand more than antibiotics alone. They require careful staging: remove infected/necrotic tissue, deliver high local antibiotic concentrations, restore stability, and re‑establish bone biology.
Our approach is evidence‑based and pragmatic. We confirm the diagnosis, identify the organism(s), and build a plan that balances infection eradication with timely reconstruction—so you can heal and return to function with lower chance of recurrence.
Signs, Symptoms & When to Seek Care
Local symptoms
Persistent or recurrent pain, swelling, warmth, redness, draining sinus, or wound that won’t close.
Systemic features
Fever/chills (often absent in chronic cases), fatigue, or high inflammatory markers.
Nonunion clues
Pain with weight‑bearing months after fracture, implant failure, deformity, or abnormal motion at the fracture site.
Red flags: new severe pain, high fever, spreading redness, uncontrolled diabetes, or signs of sepsis—seek urgent assessment.
Diagnosis & Microbiology
- Lab markers: ESR/CRP trends; WBC can be normal in chronic cases.
- Imaging: X‑rays for hardware/union status; CT for bone detail; MRI with contrast for marrow/soft‑tissue tracts; nuclear scans selectively.
- Deep cultures: Multiple intra‑operative tissue samples from representative zones—avoid surface swabs.
- Pathology & histology: Confirms necrotic bone (sequestrum) and active infection.
We plan surgery to obtain accurate samples before starting or changing antibiotics, unless you are septic and need immediate coverage.
Principles of Management
1) Debridement
Remove all infected/necrotic bone and soft tissue; open and clean sinus tracts; excise the biofilm interface.
2) Dead space control
Fill with antibiotic‑loaded carriers (cement beads/spacers) or biologic options to prevent fluid pockets and support local antibiotic levels.
3) Stability
Infected bone will not heal without stability: external fixator, exchange nailing, or staged plating depending on pattern and soft tissue.
4) Soft‑tissue coverage
Achieve robust skin/muscle coverage; involve plastic surgery when needed for flaps/grafts.
Stage 1: Debridement, Dead Space & Local Antibiotics
Stage 1 removes infection sources, obtains cultures, and delivers high local antibiotics. Where implants are loose or surrounded by pus/biofilm, they’re removed. Stable, well‑integrated hardware may be retained in select acute cases, but chronic or loose constructs are generally exchanged or removed.
- Debridement: Systematic removal of sequestrum, fibrous tissue, pus; lavage with ample sterile solution.
- Local antibiotics: Vancomycin/gentamicin‑loaded PMMA beads/spacers or resorbable carriers achieve high site concentrations.
- Induced membrane (Masquelet): Cement spacer creates a biologically active membrane for Stage‑2 bone grafting.
- Temporary stability: External fixator, spanning frames, or provisional constructs to maintain alignment.
We send multiple tissue cultures; final antibiotic choices depend on organism/susceptibility and ID guidance.
Soft‑Tissue Coverage & Skin Integrity
Healing rests on healthy coverage. We aim for primary closure when possible; if not, we coordinate flaps with plastic surgery. Negative‑pressure wound therapy may bridge to definitive closure. Pin‑site care and dressing protocols are taught to you and your caregiver to reduce infection risk.
- Coverage plan: Local/regional flaps as needed; timing coordinated with infection control.
- Pin‑site care: Daily cleaning; early management of irritation; avoid crust buildup.
- Nutrition: Protein‑rich diet supports soft‑tissue and bone healing.
Stage 2: Reconstruction & Stability
Once infection is controlled (clinical improvement, down‑trending ESR/CRP, healthy soft tissues), we reconstruct bone and restore durable stability. Options depend on the problem:
Exchange nailing
For infected nonunion of femur/tibia shafts—removal of prior nail, reaming (debridement), and larger‑diameter new nail with interlocking; often combined with local antibiotics.
Plates & bone grafts
For peri‑articular or metaphyseal defects; anatomic reduction and stability with autograft/allograft or bone substitutes as needed.
Masquelet (induced membrane)
Stage‑1 spacer induces a vascular membrane; Stage‑2 opens the membrane and packs bone graft to fill defects.
Bone transport (Ilizarov/Hexapod/RAIL)
For large segmental defects or infected nonunion with bone loss—gradual transport rebuilds continuity and alignment.
Systemic Antibiotics & ID Coordination
Local antibiotics are powerful, but systemic therapy guided by culture/susceptibility and an infectious disease (ID) specialist remains essential. Typical courses are 4–6 weeks for chronic osteomyelitis (IV and/or highly bioavailable oral agents), adjusted to organism and surgical progress. We track labs, monitor for side effects, and adapt therapy as wounds and markers improve.
- Culture‑directed: Avoid unnecessary broad coverage once results are back.
- Biofilm considerations: Some agents penetrate biofilms better; we align antibiotic choice with implant strategy.
- Monitoring: CBC, renal/hepatic function, inflammatory markers; adverse‑effect vigilance.
Anesthesia & Pain Strategy
We use multimodal, opioid‑sparing pain management. Regional nerve blocks reduce immediate post‑op pain. Scheduled paracetamol and anti‑inflammatories (where appropriate) form the base; short‑course opioids are reserved for breakthrough pain. Sleep hygiene and simple routines reduce discomfort and improve recovery.
- Regional anesthesia: Femoral/sciatic/brachial blocks as indicated.
- Simple dosing schedules: Stay ahead of pain; avoid over‑sedation.
- Delirium awareness: Especially for older adults; keep hydration and orientation.
Rehabilitation & Weight‑Bearing
We provide a written, phase‑based plan and coordinate with your physiotherapist; we do not provide in‑house physiotherapy. Early goals: swelling control, safe transfers, and protected mobility. As stability improves, we progress range‑of‑motion, strengthening, and gait. Weight‑bearing advances based on fixation stability, bone quality, and X‑ray evidence of healing.
- Week 0–2: Elevation, wound care, pin‑site care, isometrics, safe partial weight‑bearing if allowed.
- Week 3–6: Increase ROM and strength; staged weight‑bearing per plan; brace/frame care.
- Week 6–12: Progressive strengthening and endurance; device wean when safe; balance training.
- Month 3–6+: Functional training; return to work/activities based on healing and strength.
Risks, Outcomes & Limb Salvage
Potential benefits
Infection control, stable union, restored alignment and function, limb salvage, and pain reduction.
Possible risks
Re‑infection, nonunion/malunion, joint stiffness, nerve irritation, hardware issues, DVT/PE, wound problems.
Success factors
Thorough debridement, stable fixation, organism‑matched antibiotics, soft‑tissue coverage, smoking cessation, and protocol adherence.
While limb salvage is feasible in many cases, we discuss realistic outcomes and, rarely, situations where amputation may offer faster recovery or better function.
Cost & Insurance
Costs depend on staging (one vs two‑stage), implant strategy (spacers, external fixators, nails/plates), hospital stay, plastic surgery involvement, and antibiotic duration. Most insurers cover medically necessary debridement and reconstruction. We verify benefits and provide a transparent estimate before scheduling your Osteomyelitis and Infected Nonunion in Delhi treatment.
- Insurance pre‑authorization & benefits check
- Clear estimate of out‑of‑pocket costs
- Cashless/financing options where applicable
How to Prepare
Medical optimization
Control diabetes and blood pressure; stop smoking (critical for union); review anticoagulants with your physician.
Records & imaging
Bring prior operative notes, cultures, antibiotic history, and all imaging; we’ll order targeted studies if needed.
Home setup
Clear walking paths, ensure good lighting, add bathroom safety, and plan caregiver support for dressing and pin‑site care.
Physio coordination
We do not provide in‑house physiotherapy; share your physiotherapist’s contact so we can align written protocols.
Nutrition & sleep
Protein‑rich diet (1–1.2 g/kg/day if permissible), vitamin D/calcium where indicated, and regular sleep to support healing.
Where to Consult Dr. Neelabh
BLK Hospital
A-4-6, Pusa Rd, Near Rajendra Place Metro Station, New Delhi-110005
🕓 4:00 PM – 6:00 PM
Timings may vary—please call +91‑9810117204 to confirm.
FAQs
Why not treat osteomyelitis with antibiotics alone?
How long will I be on antibiotics?
Will all hardware be removed?
What if bone is missing?
Do you provide physiotherapy?
Need a staged plan for Osteomyelitis and Infected Nonunion in Delhi?
Book a consultation. We’ll confirm the diagnosis, plan cultures and debridement, and map a safe path to infection control and union.