Acute osteomyelitis

ACUTE OSTEOMYELITIS

NUR HANISAH ZAINOREN

OSTEOMYELITIS

ACUTE CHRONIC

PRIMARY SECONDARY

HEMATOGENOUS FOLLOWING AN OPEN FRACTURE/BONE OPERATION

Infection of the bone by pyogenic micro-organisms

• Highly vascularized zone

• Venous system begins in this area and drains towards the diaphysis

• Vessel are arranged in the form of hair-pin arrangement blood stasis responsible for the metaphysis being the favourite site for bacteria osteomyelitis

METAPHYSIS OF LONG BONE

TYPES OF METAPHYSIS

AETIOPATHOGENESIS• Staph. aureus commonest causative organisms

• Others: Streptococcus & Pneumococcus

• Reach the bone via blood circulation

• Lodged in the metaphysis – Lower femoral metaphysis *commonest– Upper femoral metaphysis– Upper tibial metaphysis– Upper humeral metaphysis

• Disease of CHILDHOOD, more common in BOYS, probably because they are more prone to injury

• Diagnosis is clinical

• Presenting complaints: – Pain– Swelling – Fever– Chills and rigor

• Examination:– Febrile and dehydrated– Red, hot, tender, swelling, edema– Abscess in the muscle or subcutaneous plane (later stages)– There may be swelling of the adjacent joint

• Investigations:– Blood:

• PMN leucocytosis• Elevated ESR• Blood culture at the peak of the fever

may yield the causative organism

– X-rays:• Earliest sign (7-10 days):

periosteal new bone deposition at the metaphysis (periosteal reaction)

– Bone scan (Technetium-99):• May show increased uptake by the

bone in the metaphysis (positive before changes appear in x-ray)

• Differential diagnosis:a) Acute septic arthritisb) Acute rheumatic arthritisc) Scurvyd) Acute poliomyelitis

*Any acute inflammatory disease at the end of a bone, in a child, should be taken as acute osteomyelitis unless proved otherwise.

*Any history of trauma, must be thoroughly questioned

• Treatment:Within 48 hours of the onset of symptoms

• Pus not yet formed and the inflammatory process can be halted by systemic antibiotics

• Consists of rest, antibiotics and general building-up of the patient Rest - Limb is put to rest in a splint or by traction

Antibiotics - choices varies depend on the age of the child & choice of the doctor

General – rehydration with IV fluids, weight bearing restriction for 6-8 weeks

• Treatment:After 48 hours of the onset of symptoms

• Child is brought late or does not respond to conservative treament Collection of pus within or outside the bone

• Detection of pus by ultrasound examination (because it may lie deep to the periosteum)

• Surgical exploration and drainage

• Antibiotics are continued for 6 weeks

• Complications:– General complications:• Septicaemia• Pyemia

– Local complications:• Chronic osteomyelitis• Acute pyogenic arthritis• Pathological fracture• Growth plate disturbances

SECONDARY OSTEOMYELITIS • Arises from a wound infection in an open

fractures or after operations on the bone

• Less severe than hematogenous osteomyelitis (as wound provide some drainage)

• Prevention: – adequate initial treatment of open fractures– adherence to sterile operating conditions

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