OSTEOMYELITIS

INFECTIOUS PROCESS OF THE BONE AND ITS MARROW IS CALLED

OSTEOMYELITIS

INFECTION OF JOINT IS CALLED

SEPTIC ARTHRITIS

TYPES OF OSTEOMYELITIS• ACCORDING TO DURATION

– ACUTE– SUBACUTE e.g. BRODIE”S ABSCESS– CHRONIC

• ACCORDING TO MECHANISM– EXOGENOUS (TRAUMA, SURGERY, CONTIGIOUS

INFECTION)– ENDOGENOUS OR HAEMATOGENOUS

• ACCORDING TO HOST RESPONSE– PYOGENIC– NON PYOGENIC e.g. GRANULOMATOUS, VIRAL, FUNGAL

BACTARIOLOGY

PATHOPHYSIOLOGY

COMMON SITES OF INFECTION

NATURAL HISTORY

• INFLAMMATION• SUPPURATION• NECROSIS• REACTIVE NEW BONE FORMATION• RESOLUTION

CLINICAL FEATURES

• CHILDREN PAIN FEVER MALAISE TENDERNESS

• INFANTS FAILS TO THRIVE IRRITABLE LESS CONSTITUTIONAL SYMPTOMS

INVESTIGATIONS

• BLOOD WBC,ESR, BLOOD CULTURE• C – REACTIVE PROTEINS• ASPIRATE MICROSCOPY,CULTURE• XRAYS• BONE SCAN (Tc.Ga. Indium)• MRI

DIFFERENTIAL DIAGNOSIS

• CELLULITIS• BONE TUMOUR• STREPTOCOCCOL MYOSITIS• PERIOSTIETIS• AC.RHEUMATISM• SICKLE CELL DISEASE• GAUCHER’S DISEASE

SEQUENCE OF TREATMENT

• IMMEDIATE ADMISSION• INVESTIGATIONS• ANELGESICS• SPLINTAGE• ANTIBIOTICS (IF NO IMPROVEMENT WITHIN 24_36 Hrs)

• SURGICAL INTERVENTION IS INDICATED

TREATMENT ANTIBIOTICS

• <06MONTHS OF AGE (STAPH, STREP, GM-VE)

Flucloxacin plus 3rd Generation cepholosporin• 6Months-6Years (H.Influenza)

Flucloxacin plus 3rd Generation cepholosporinSecond generation cepholosporin(cefuroxime)

• Older children and AdultsMajority have staphylococcal infectionFlucloxacin and fusidic acid

• Sickle cell diseasesalmonella or other gram neg organismsthird generation ceph or quinolone

• Elderly and Unfit patientsgreater than usual risk of gram neg infectionflucloxacin plus third generation ceph

• Immunocompromisedunusual infection- psuedomonos, proteus, anaerobes

TREATMENT SURGICAL

• ASPIRATION• INCISION/DRAINAGE• PERIOSTIAL INCISION• BURR HOLES• SEQUESTRECTOMY IF NEEDED

CH. OSTEOMYELITIS

• ACUTE _____CHRONIC

• CHRONIC TO START WITH e.g. TB, FUNGUS

• POST.TRAUMATIC COMPOUND FRS.

• POST. OPERATIVE

MORBID ANATOMY

• THICKENED BONE• SEQUESTRAE• INVOLUCRUM• CLOACAE• PUS /GRANULATION TISSUE• IMPLANTS ,CEMENT.

CLINICAL FEATURES

• PAIN• WITH OR WITHOUT LOW GRADE

FEVER• DISCHARGING SINUSES• SCARS

INVESTIGSTIONS

• BLOOD CP. WBC,ESR,HB%• ASPIRATE C.S.• XRAYS• C.T.• M.R.I.• RADIO ISOTOPE BONE SCAN Tc.,Ga.

TREATMENT

• ANTIBIOTICS• LOCAL TREATMENT SKIN CARE DRESSENGS• OPERATIVE

OPERATIVE TREATMENT

• SEQUESTRECTOMY• DEBRIDEMENT• SAUCERIZATION• CONTINUOUS IRRIGATION• DOUBLE LUMEN TUBES• GENTYCIN BEADS• MUSCLE FLAPS• PAPINEAU TICHNIQUE• IMPLANT REMOVAL/EXTENAL FIXATOR

POST. TRAUMATIC OSTEOMYELITIS

ESSENCE OF TREATMENT IS PROPHYLAXISIN ESTABLISHED CASES DEBRIDEMENT DRAINAGE REPEATED WOUND EXISIONS REMOVAL 0F LOOSE IMPLANTSUSE EXTERNAL FIXATION OTHERWISE

KEEP IMPLANT TILL UNION

POST. OPERATIVE OSTEOMYELITIS

• EARLY WITHIN 03 MONTHS SUPERFICIAL DEEP BOTH

• LATE FOLLOWING EARLY COVERT INFECTION FOLLOWING A LONG COARSE OF NORMALCY

PROPHYLAXIS AGAINST POST. OP. OSTEOMYELITIS

• AVOID OP. ON IMMUNOSUPPRESSED• TREAT FOCUS OF INFECTION• OPTIMAL STERILIZATION• PROPHYLACTIC ANTIBIOTICS• SURGICAL TECHNIQUE• ULTRA CLEAN OP.THEATRE

OSTEOMYELITIS AFTER ORIF. OF FRS.

STABLE SEPTIC FRACTURE IS BETTERTHAN UNSTABLE SEPTIC FRACTURE

SO KEEP THE IMPLANT TILL UNION ORCONVERT TO EXTERNAL FIXATION