Osteomyelitis
GHADI ALMUTAIRI
DHAI ALTUWAIJRI
Objectives
01.
Define acute and chronic osteomyelitis.
02.
Recall the etiopathogenesis of bone infection.
03.
Discuss and differentiate the clinical presentations of acute and chronic osteomyelitis.
04.
Demonstrating radiological feature of acute and chronic osteomyelitis.
05.
Plan the general and specific investigations and management for acute and chronic
osteomyelitis.
Osteomyelitis
an acute or chronic inflammatory process of the bone and its structures
secondary to an infection.
Staphylococcus aureus Is the most common causative organism (90%).
Pathophysiology
Microorganisms entry by:
A- direct bone contamination: surgery, open fracture , trauma , prosthesis.
B- indirect: Hematogenous(most common) ,Extension of soft tissue infection.
Pathophysiology
Microorganism enter the bone -> inflammation, pus formation , edema ->
inc. interossous pressure -> impaired blood flow.
After 2 or 3 days, thrombosis of the blood vessels occurs in the area, resulting in
ischemia with bone necrosis.
Pathophysiology
Sequestrum (the dead necrotic bone) forms.
New bone growth, the involucrum forms and surrounds the sequestrum.
cloaca (an opening in the involucrum through which pus escap)later forms.
clinical manifestation
Local : pain, tenderness,redness, warmth, restricted ROM , swelling
, drainage from the site of infection.
systemic: fever, malaise , shivering,headache nausea.
Radiology
4- Demonstrating radiological feature of acute and chronic osteomyelitis
4- Demonstrating radiological feature of acute and chronic osteomyelitis
4- Demonstrating radiological feature of acute and chronic osteomyelitis
4- Demonstrating radiological feature of acute and chronic osteomyelitis
4- Demonstrating radiological feature of acute and chronic osteomyelitis
• Plain radiographs :
In the initial phase of osteomyelitis there may be no visible changes on plain radiographs. Later, bone resorption
and a periosteal reaction are usually seen.
X-Ray
4- Demonstrating radiological feature of acute and chronic osteomyelitis
CT :
useful in detecting an island of dead bone (sequestrum), which can lie within an involucrum of reactive live bone.
4- Demonstrating radiological feature of acute and chronic osteomyelitis
US :
may detect a sub periosteal collection of fluid in the early stages of osteomyelitis
4- Demonstrating radiological feature of acute and chronic osteomyelitis
MRI :
Bone oedema is readily apparent and the extent of the infection can be defined.
Definitive diagnosis is made with aspiration or positive clinical picture with convincing MRI.
Management
5-PLAN
THE
GENERAL
AND
SPECIFIC INVESTIGATION AND
AND CHRONIC OSTEOMYELITIS
MANAGEMENT
FOR
ACUTE
5-PLAN
THE
GENERAL
AND
SPECIFIC INVESTIGATION AND
AND CHRONIC OSTEOMYELITIS
MANAGEMENT
Laboratory investigations:
•The C-reactive protein (CRP) values are usually elevated within 12–24 hours
• Erythrocyte sedimentation rate (ESR) within 24–48 hours
• (WBC) count rises and the haemoglobin concentration may be diminished.
FOR
ACUTE
5-PLAN
THE
GENERAL
AND
SPECIFIC INVESTIGATION AND
AND CHRONIC OSTEOMYELITIS
MANAGEMENT
FOR
ACUTE
Treatment :
• IV antibiotics are the best initial treatment if osteomyelitis is diagnosed early.
• If no subperiosteal abscess or abscess within the bone
• Broad-spectrum antibiotics are initially chosen, followed by antibiotics specific for the organism
cultured from percutaneous aspiration/biopsy.
- CRP can be used to monitor the therapeutic response to antibiotics.
- Failure to decline within 48 to 72 hours warrants alteration in treatment.
5-PLAN
THE
GENERAL
AND
SPECIFIC INVESTIGATION AND
AND CHRONIC OSTEOMYELITIS
MANAGEMENT
FOR
ACUTE
• If failure to respond to antibiotics, appearance of frank plus on MRI, or presence of a sequestered
abscess >>> operative drainage and débridement.
Reference
REFERENCES:
I. MCRAE’S ORTHOPAEDIC
II. MILLER'S REVIEW OF ORTHOPAEDICS
III. APLEY'S SYSTEM OF ORTHOPAEDICS AND FRACTURE
IV.HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC2884903/
V.HTTPS://RADIOPAEDIA.ORG/CASES/CHRONIC-VS-ACUTE-OSTEOMYELITIS-ILLUSTRATION
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