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Osteomyelitis | Powerpoint Slide lecture

| January 22, 2011 | 0 Comments

 

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Osteomyelitis

  • The term osteomyelitis does not specify the causative organism or the disease process

Osteomyelitis

Classification:

  • Duration         –       Acute, Subacute or Chronic
  • Route of infection -Hematogenous or Exogenous
  • Host response    -  Pyogenic or Granulomatous

Acute Pyogenic Osteomyelitis

 

Definition:

  • AO is an infection of bone involving the periosteum, cortical bone and the medullary cavity.

Acute Pyogenic Osteomyelitis

Incidence:

  • Age                             more in children
  • Sex                            boys > girls
  • Bone affected            all bones
  • Site of infection           metaphysis

Acute Pyogenic Osteomyelitis

Organism:

  • Neonates:Osteomyelistis Osteomyelitis | Powerpoint Slide lecture

Staph aureus, Strept, E coli

  • Children:

Staph aureus, E coli, Serriata, Pseudomonas, H inf

  • Sickle-cell anemia:

Staph aureus, Salmonella

 

Acute Pyogenic Osteomyelitis

Source of Infection:

  • Hematogenous
  • Direct spread
  • Exogenous

 

Acute Pyogenic Osteomyelitis

Pathology:

  • Primary focus and stage of inflammation
  • Spread of infection with pus formation
  • Formation of subperiosteal abscess
  • Pus tracks toward skin to form a sinus
  • Bone infarction (Sequestrum)
  • New bone formation (involucrum)

Acute Pyogenic Osteomyelitis

Age variation

Neonates:

  • Extensive bone necrosis
  • Increased ability to absorb large sequestrum
  • Increased ability to remodel
  • Epiphysio-metaphyseal vascular connection leading to secondary septic arthritis

Acute Pyogenic Osteomyelitis

Age variation

Adults:

  • No subperiosteal abscess due to adherent periosteum
  • Soft tissue abscess
  • Vascular connection with the joint leading to secondary septic arthritis

Acute Pyogenic Osteomyelitis

Clinical Pictures

History:

 

Skin lesion

Sore throat

Trauma

Acute Pyogenic Osteomyelitis

Classification:

  • Duration         –       Acute, Subacute or Chronic

Symptoms:

  • Pain, restless
  • Malaise and fever
  • The limb is held  still (pseudo paralysis)
  • Sometimes mild or absent (neonates)

Acute Pyogenic Osteomyelitis

Clinical Pictures

Signs:

General and Local

Laboratory Tests:

    • CBC
    • ESR+CRP
    • Blood culture (+ve in 50-70%)
    • Aspiration (Gram stain + culture and sensitivity)

Acute Pyogenic Osteomyelitis

Radiography

  • Plain X-ray
  • Ultrasound
  • Bone & gallium scan (Sensitive but not specific)
  • CT scan
  • MRI

Acute Pyogenic Osteomyelitis

Differential Diagnosis

  • Acute Septic Arthritis
  • Acute monoarticular rheumatoid arthritis
  • Sickle cell crisis
  • Cellulitis
  • Ewing’s Sarcoma

Acute Pyogenic Osteomyelitis

Treatment

General:

  • Hospitalization
  • Hydration
  • Electrolyte replacement
  • Analgesia
  • Immobilization

Acute Pyogenic Osteomyelitis

Treatment

Antibiotics:

      • Type?
      • Route?
      • When to start?
      • When to stop
      • Monitoring?

Acute Pyogenic Osteomyelitis

Treatment

Surgical Drainage:

      • Indications?
      • Procedure?
      • Drilling?

Acute Pyogenic Osteomyelitis

Prognosis

Factors affecting prognosis:

  • Organisms
  • Infected Bone
  • Age of the Patient
  • Treatment

Acute Pyogenic Osteomyelitis

Complications

  • Septicemia & metastatic abscesses
  • Septic arthritis
  • Growth disturbance (children)
  • Pathological fracture
  • Chronic osteomyelitis

Subacute Osteomyelitis

  • Longer history and less virulent organism
  • Insidious onset, Mild symptoms
  • Pain is the most consistent symptom
  • Usually no constitutional  symptoms

Subacute Osteomyelitis

  • Abnormal initial radiographs
  • Inconclusive laboratory data
  • Negative cultures/ biopsy
  • Difficult to distinguish from bone tumors  e.g. Ewing’s, osteosarcoma

Chronic Osteomyelitis

Factors responsible for chronicity

  • Local factors: Cavity, Sequestrum, Sinus, Foreign body, Degree of bone necrosis
  • General: Nutritional status of the involved tissues, vascular disease, DM, low immunity
  • Organism: Virulence
  • Treatment: Appropriateness and compliance
  • Risk factors: Penetrating trauma, prosthesis, Animal bite

Chronic Osteomyelitis

Types

  • A complication of acute Osteomyelitis
  • Post traumatic
  • Post operative

Chronic Osteomyelitis

Clinical picture

  • Continuous or intermittent suppuration and sinus formation with acute exacerbations.
  • Pain, fever, redness, and tenderness during acute exacerbations.
  • Discharging sinus with +ve/-ve culture.
  • Pathological fracture.

Chronic Osteomyelitis

Investigation

  • Lab tests/ culture
  • Plain X-ray:

Bone rarefaction surrounded by the dense sclerosis, sequestration and cavity formation

  • Sinogram
  • Bone scan & gallium scan

To detect chronic multifocal osteomyelitis

Chronic Osteomyelitis

Treatment

  • Antibiotics
  • Surgical treatment

Preoperative assessment  & preparation

Derbridement

Sequestrectomy

Local antibiotics

Stability

Treatment of bone cavity

Chronic Osteomyelitis

Complications

  • Recurrence & Recurrence & Recurrence
  • Pathological fractures
  • Growth disturbance
  • Amyloid disease
  • Epidermoid carcinoma of the fistulas-ppt.html">fistula

Septic Arthritis

  • Septic arthritis is an infection of the joint usually bacterial, as viral arthritis is usually self limiting and treatment is supportive.
  • 50% of cases in children <3 years
  • The hip joint is the common site in <3years, whereas the knee joint is more common in older children.

Acute Septic Arthritis

  • Organism?
  • Route of infection?
  • Pathology:

Serous or acute synovitis

Serofibrinous

Suppurative (purulent) arthritis

Acute Septic Arthritis

Clinical Pictures

  • General manifestations:

constitutional symptoms and signs of acute infection

  • Local manifestation:

Swelling, hotness and redness

Deformity with muscle spasm

Restriction of all movements of the joint

The joint is fixed in the position of ease

Acute Septic Arthritis

Investigations

  • Lab tests/ cultures
  • Plain X-ray
  • Bone scan & Gallium scan
  • Ultrasound
  • Aspiration:  if WBC >50,000with >90% PMNLs suspect septic arthritis even if culture is negative.

Acute Septic Arthritis

Differential Diagnosis

  • Acute osteomyelitis
  • Transient synovitis of the hip (<10)
  • Acute  rheumatic fever
  • Haemoarthrosis
  • Haemophilic arthritis

Acute Septic Arthritis

Treatment

  • Aspiration
  • Antibiotics
  • Splintage
  • Surgical drainage
  • Treatment of complications
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