ACUTE HAEMATOGENOUS OSTEOMYELITIS

Assistant prof. : Dr. Omer BarawiConsultant Orthopedist

Children ( commonest ) Adult ( immunodepresive conditions )

Staphylococcus aureus Streptococcus pyogenes strep. Pneumonia Haemophilus influenzae sickle-cell anaemia ..salmonella The organisms usually settle in the metaphysic at

the growing end of a long bone, possibly because the hairpin arrangement of capillaries slows down the rate of blood flow.

In young infants the epiphysis may be involved. In adults ,haematogenous infection is more

common in the vertebrae than in the long bones.

Inflammation Suppuration Necrosis New-bone formation Resolution

usually a child , presents with pain, malaise and

fever; inneglected cases toxaemia may be marked. Sometimes a history of a preceding skin lesion, an injury or a sore throat may be obtained.

In infants, especially in the newborn, the

constitutional disturbance can be misleadingly mild;the baby simply fails to thrive and is drowsy but irritable. Suspicion should be aroused by a history of birth difficulties or umbilical artery catheterization. There may be metaphysel tenderness and resistance to joint movement. Always look for other sites – multiple infections are not uncommon.

In adults the commonest site of haematogenous

infection is the spine. Suspicious features are backache and a mild fever, possibly following a urological procedure. It may take weeks for x-ray signs to appear, and then the diagnosis may need to be confirmed by fine-needle aspiration and bacteriological culture.

Plain radiograph MRI Radio-isotope scans may show increased

activity

C-reactive protein ( 12 -24 hrs) increasing ESR ( 24-48 hrs) increasing Hb (decreasing) Anti staphylococcual – antibody titre Aspirate pus from the subperiosteal abscess Blood culture WBC (increased)

Celllulitis Acute sapurative arthritis Ewing’s sarcoma Osteosarcoma Streptococal necrotizing myositis Rheomatic fever (acute rhiomatism ) Sickle cell- crisis Gaucher’s disease Stress fracture

Spread Infection may spread to the joint (septic arthritis)

or to other bones (metastatic osteomyelitis). Growth disturbance If the physis is damged, there may later be

shortening or deformity. Persistent infection Treatment must be prompt and effective.”Too little

too late” may result in chronic osteomyelitis

Antibiotics … pus culture, blood culture flucloxacillin and fusidic acid ( usually for 1 or 2 weeks) and is then followed

by oral antibiotics for another 3-6 weeks If methicillin-resistant Staphylococcus aureus

(MRSA) appears, vancomycine is the antibiotic of choice.

Analgesics Splintage Drainage Follow up