skip to main content

Chronic Osteomyelitis — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

HardBone & Joint InfectionChronic OsteomyelitisSCE Infectious Diseases

A 35-year-old man presents with a chronic discharging sinus on his right thigh 18 months after a closed femoral shaft fracture treated with an intramedullary nail. Sinogram shows communication with the nail. Deep tissue samples grow Staphylococcus aureus (MSSA). What surgical and antibiotic strategy is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Removal of the nail (if fracture healed), debridement, and 6 weeks of IV Flucloxacillin plus oral Rifampicin

Chronic osteomyelitis related to metalwork with a discharging sinus requires removal of the implant (if the fracture has healed) to eliminate the biofilm reservoir, thorough debridement of infected and necrotic bone, and targeted antibiotic therapy. For MSSA with metalwork removal, IV Flucloxacillin (2 g QDS) plus oral Rifampicin (300–450 mg BD, for anti-biofilm activity during the transition period) for 6 weeks is standard. If the fracture has not healed, a staged approach with temporary spacer may be needed.

Reference: BSAC 2015 – Bone and joint infection guidelines; NICE NG157 2024