Acute and Chronic Osteomyelitis

Acute Osteomyelitis 

Orthopaedic Diagnosis 
History 

2) Past History
3) Family History 

4) Social background

5) Examination 

Look / Feel / Move

Special tests

developmental milestones.

C ) Investigations 

Plain Radiography

   Patient - soft tissue , bones and joints 

     using contact media

2- CT

3) IMRI

5-30, 000, stronger than Earth’s magnetic field

4) Diagnostic ultrasound 

5) Radionuclide imaging - 99 m Tc

B ) Blood tests

CBC, ESR CPP - Non specific 

- Tissue typing
 - Rheumatoid factor 
- Synovial fluid analysis.

C) Bone-Biopsy 

D) Diagnostic arthroscopy 


Infection 

Direct Introduction 

(2) from contiguous infection 

(3) indirect spread from blood stream

Factors predisposing to bone infection 

- Malnutrition & general debility"
- DM
- Corticosteroid administration
- Immune deficiency
-immunosuppressive drugs.
- Venous stasis in limbs

- Peripheral l vascular diseases
 - loss of sensibility
- intrinsic invasive measures
- Trauma

Principles of treatment 

1 ) Analgesia

2) rest the affected part

3) indentify infecting organism, administer effective abx tr

4) release pus as soon as it’s detected 

5) Stabilize bone if it's fractured

6) eradicate avascular & necrotic bone

7) maintain soft tissue and skin colour 


Acute Haematogenous Osteomyelitis


Adults & Children - S. Aureus - 70%

                 -less often GABS (Str. Pyogenes) or 

                             -alpha -haemolytic Diplococus , S. Pneumoniae

1-4. children - H. Influenzae. 

                       - Kingalla kingne

Metophysis - involvement

1) Non-anastomosing losine terminal antony branches of nutrient artery

2) relative vascular stasis

3) lower oxygen tension

4) fire vessels in hypertrophic zone-bacteria pass through them and adhere to type I collagen

Pathology - 

Inflammation, suppuration, bone necrosis reactive new bone formation, resolution & healing or chronicity

Metaphysis

-Intracapsular - SHE( SHOULDER , HIP and ELBOW JOINTS ) and spreads to it.

2) Periosteum looseliy attached in children spreads along shaft.

(3) physis is barrier to spread to joint 





4) In infants ,bacteria spreads to joints 

its through physis


Clinical features 

(1) child over 4

(2) Pain, swelling , refused to move 

(3) high grade fever 

 4) Infants - symptoms are mild 
(5) Bony tenderness 

(6) TL vertebrae are comon sites 




Diagnostic Smaging

1)Plain xray

2) USG

3) 99m Tc - HDP : Increase activity in both perfusion and bone phase 

4) MRI

B) Laboratory Tests 

18 G needle.

Aspiration.

tissue aspiration 60% positive

CRP-12-24 hrs., ESP-24-48 hrs

D/P

4) Cellulitis

B) Acute suppurative Arthritis

2) Acute P
3) Rheumatism

4) Sickle cell crisis


D) Gaucher’s Disease

Treatment 
 Analgesia 

Support affected part

Abx

Pus drainage

Fix facturas

Cover wound , remove dead bone 

Choice of Abx. 

 Upto. 06 months - 3rd gen. cephalosp

                                     Covers Aureus

  6 months to 6 years - H. Influenza

Fluclox + 3rd gen ceohalosporin



Older chibaren & previously fit 

flucloxacillin & Fusidic 
 acid

Elderly previously unfit patients 

Like in 

6 months children - G ‘-’ve organisms from GI Tract , respiratory system . 

Pts. with Sickle Cell dis-

3rd gen ceohalosporins or fluoroquinolones 

MArSA-

IV Vancomycin + 3rd Gen Cephalosporin



- Garre’s Sclerosing Osteomyelitis 

Marked Sclerosis and Cortical thickening .

-Long history of bone pain and Swelling over bone 


Treatment - Curettage 

Acute suppurative Arthritis

S. Aureus

Involvement

I/A injections 
Adjacent bone abscess
Blood spread from distant site

Clinical features

1 ) Pain / swelling ) refusal to move the part, fever
2)septiceamia in infants 

3) rapid pulse, erythema over involved bone and swelling 

4 ) restricted movement 



Imaging
 
USG

X - Ray

MRI

G-stain

WBC-300/ ml is normal 


- 1000/-non infective 

> 50,000/ml - infective


D/D of Acute Osteomyelitis 

Trauma 
Irritable Joint 



4) Haemophiliac Bleed 

5) Rheumatic fever 

6) Juvenile Rheumatoid Arthritis

7) Sickles cell Disease

10) Gaucher's Disease 

11) Gout and Pseudogout

Complications 

Subluxation

Damage to cartilage

Articular cartilage erosion 

Gonococcal Arthritis

Neisseria Gonorrhoea.


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