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Acute and chronic osteomyelitisPembimbing
Dr.Jafri Hasan, SpOT
Nur Hami ah Hashim!!."#!"."$%
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Definition
• Acute osteomyelitis – &nfections of the bone
• Acute Hematogenous osteomyelitis – A rapidly de'eloping blood borne bacterial infection of
bone and its marro(
• )hronic osteomyelitis – bone infection predicated on pree*isting osteonecrosis
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+pidemiology of acuteosteomyelitis
• ost fre-uently inthe long bones
• / 0 !
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+tiology of acute osteomyelitis
• Portal of entry – Scratches, abrasions
etc –
ucous membrane ofrespiratory tract – 1ocal trauma
2#3
!#3
staphylococcus aureus streptococcus andpneumococcus
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Patogenesis of acute osteomyelitis
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Symptoms
• High fe'er and chills 4may beabsent in infants5
• S(elling, redness and (armtho'er the infected area
• 6estricted range of mo'ement inthe affected area
• &f osteomyelitis de'elopsfollo(ing an in7ury then thesymptoms may include puscoming out from a (ound
•
&rritability in young children• 8eneral discomfort, malaise,uneasiness
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Diagnosis
• 1eucocytes count increase• 9:ray (ill be seen normal
in the ! st (ee;•
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Treatment
• Supporti'e measures> eg intra'enous fluid• 6emo'able splint to pre'ent fractures• =road spectrum antibiotics•
Surgical decompression 4after "$ hours ofintensi'e treatment (ithout impro'ement5 – Drilling of bone – +'acuation of the subperiosteal pus
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Prognosis
• Depends on – Time inter'al bet(een the onset of infection and the
treatment – The effecti'eness of the antibiotics and the causati'e
bacteria – The dosage of the antibacterial drugs
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)omplications
• +arly – Death from septicemia – Abcess formation – Septic arthritis
• 1ate – )hronic osteomyelitis – Pathological fracture – Joint contracture –
1ocal gro(th disturbance
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Chronic HematogenousOsteomyelitis
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)hronic hematogenousosteomyelitis
• &nade-uate treatment of acute phase – ?ailure to diagnose acute osteomyelitis – ?ailure to pro'ide effecti'e antibacterial therapy – ?ailure to inter'ene surgically (hen indicated in the acute
phase
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Pathogenesis
?ormation of a se-uestrum 4A5,sound bone> 4=5, ne( bone> 4)5,
granulations lining in'olucrum>4D5, cloaca> 4+5, se-uestrum
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)linical features
• S(elling• Tenderness• 1oss of function•
aybe one or more draining sinuses
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Diagnosis
• 6adiography – Presence of
se-uestra –
=rodie@s abcess
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Treatment
• +*trudedspontaneously througha cloaca
• Se-uestrectomy• Sauceri ation
– the e*ca'ation of tissue toform a shallo( shel'ingdepression, usuallyperformed to facilitatedrainage from infectedareas of bone.
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)omplications
!. Joint contracture". Pathological fracture0. Amyloid disease
$. alignancy of the epidermis4epidermoidcarcinoma5
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