Osteomyelitis & Biofilm: When Bugs Hide in Bone

In this episode of BoardsCast, we take on osteomyelitis — one of the most frustrating and persistent complications in orthopedic surgery — and dive into how bacterial biofilm formation changes everything.

You’ll learn:

• How biofilms form and why they protect bacteria from antibiotics
• The difference between acute and chronic osteomyelitis
• Which bacteria are most commonly involved — and what they stick to
• When to debride, when to remove implants, and when to stage reconstruction
• The role of local vs. systemic antibiotic therapy
• How to recognize implant-associated infection and what happens if you miss it

Whether you're facing a draining tract, a failed repair, or planning a second-look surgery, this episode builds a framework for handling bone infections with confidence.

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Chapters

• 0:00 Introduction: Implants, Bacteria, and the Challenge of Deep Infection
• 1:27 Implants and Infection Risk: External Fixation (ESF) and Pin Tracts
• 2:52 Minor vs. Major Pin Tract Infections: Clinical Distinctions
• 4:57 Combined IM Pin/ESF Frames: Increased Osteomyelitis Risk
• 5:49 Pathophysiology of Bone Infection: Hostile Environment and Biofilm
• 7:02 Why Antibiotics Alone Aren't Enough: The Biofilm Fortress
• 8:09 Surgical Management Principle 1: Debridement ("Dead Bone = Dead Weight")
• 9:01 Surgical Management Principle 2: Implant Removal (When to Keep/Remove)
• 10:20 Bone Grafting: Contraindication in Active Infection
• 11:17 Three Requirements for Bone Healing: Stability, Vascularity, Low Bioburden
• 12:08 Monitoring Infection: Radiographs Lag, Clinical Signs are Key
• 12:56 The Winning Formula for Established Infection
• 13:34 Flashcard Recap: Essential Takeaways
• 14:48 Conclusion: Strategic Surgical Management of Bone Infection