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Acute Osteomyelitis: Incidence

The document provides an overview of acute and chronic osteomyelitis, highlighting its incidence, aetiology, common causal organisms, clinical features, investigations, and treatment options. Acute osteomyelitis is more prevalent in children and often results from bacteraemia or direct infection, while chronic osteomyelitis may follow inadequate treatment of acute cases. Treatment includes antibiotics, surgical intervention when necessary, and rehabilitation, with potential complications such as septicemia and chronic infection.

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Kaung Khant
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4 views5 pages

Acute Osteomyelitis: Incidence

The document provides an overview of acute and chronic osteomyelitis, highlighting its incidence, aetiology, common causal organisms, clinical features, investigations, and treatment options. Acute osteomyelitis is more prevalent in children and often results from bacteraemia or direct infection, while chronic osteomyelitis may follow inadequate treatment of acute cases. Treatment includes antibiotics, surgical intervention when necessary, and rehabilitation, with potential complications such as septicemia and chronic infection.

Uploaded by

Kaung Khant
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Ortho Eindra

ACUTE OSTEOMYELITIS
Incidence

 Age – more common in children


 Sex – M>F

Aetiology
1. Bacteraemia ( from CSOM, sinusitis, ischio-anal abscess )
2. Direct extension of infection from
 Nearby soft t/s infection
 Septic arthritis of adjacent joint

Predisposing factors
1. Lowered general ressitance
2. Malnutrition
3. Local trauma
4. IVDU

Common causal organisms


1. Staph aureus ( 80% )
2. Gonococci ( in sexually active ages )
3. Gram (-)ve ( in elderly )
4. H.influenzae ( common at <2yr of age )
5. Staph albus
6. Salmonella

Common sites
1. Tibia ( Upper end )
2. Humerus ( Upper end )
3. Femur ( Lower end )
4. Radius ( Lower end )

CLINICAL FEATURE
History
 Age – most common in children
 h/o – skin infection , abscess or infection in any other part of the body, h/o trauma may be +
 chief complaints
 General  fever, malaise, loss of appetite & failure to thrive
 Local  painful swelling with some restriction of adjacent joint movment

Physical examination
General
 Febrile, Tachycardia
 Ill & toxic if septicemia (+)

Local
 LOOK
Ortho Eindra

 Swelling, redness & signs of inflammation


 Subcutaneous abscess & pus-discharging sinuses may be +
 Swollen adjacent joint may be + d/t effusion

 FEEL
 Tenderness & raised temp: over the swelling

 MOVE
 Movement of the adjacent joint is possible

INVESTIGATIONS
1. Blood for CP – leukocytosis
2. ESR – raised
3. CRP – raised
4. Blood for C&S- taken before antibiotic therapy
5. Pus for C&S- taken from primary focus of infection or from soft t/s abscess
6. Bone X-rays
 1st few days no abnormal radiological features
 After 2-3 wks  some rarefaction in the bone at metaphysis ( d/t local hyperaemia ),
soft t/s swelling, faint extracortical outline d/t periosteal new bone formation
7. MRI scan – can get the Dx in early stage, Invx of choice nowadays
8. Isotope bone scanning- can get Dx before X-ray changes

TREATMENT
I. General Treatment
 Analgesics
 Before C&S result  IV BS antibiotics which can penetrate Bone
( eg: Flucloxacillin x 3-6wks )
After C&S  change according to the result
 Nutritional support
 IV fluids & electrolyte
 Monitoring of response to Tx

II. Local Treatment


 Rest the affected part
 Splintage by POP posterior slab or traction

Indications for Surgery


 Failure to respond to antibiotic therapy
 Presence of an abscess
 Late cases ( >48hr )

Surgical exploration
 Apply tourniquet to the limb
 Incision is made over the tender area down to the bone
 Locate the subperiosteal abscess
 Abscess cavity is fully opened & drain the pus
Ortho Eindra

 Drill the cortex & drain the pus from the medulla
 Close the wound with interrupted sutures over a closed, sterile suction drain

 Rehabilitation of affected limb

COMPLICATIONS
1. General
 Septicemia
 Metastatic abscess
2. Local
 Chronic OM
 Spontaneous #
 Septic arthritis of nearby joints
 Deformity & limb-length inequality
Ortho Eindra

CHRONIC OSTEOMYELITIS

CLINICAL FEATURES
 h/o acute OM (+)  inadequate or no Tx taken
 may remain quiescent
 exacerbation may occur with
 constitutional symptoms ( fever, anaemia, malaise, anorexia , wt loss )
 local features of inflammation ( Pain, tenderness, swelling & redness )

relived by d/c of pus from a pre-existing sinus


 Overlying skin
 Thin & adherent to bone
 Healed scar
 Pus-discharging sinuses

INVESTIGATIONS
1. Blood for CP – polymorphonuclear leukocytosis
2. ESR – very high
3. Pus for C&S
4. X-ray
 Distorted bone architecture
 Areas of rarefaction
 Raised periosteum ( Calot’s triangle )
 Involucrum formation
 Sunray appearance
5. Sinogram- aid to detect abscess cavity in the bone & course of the sinus tract

TREATMENT
General
 Analgesics & antibiotics
 Nutritional support

Local
 Resting the affected limb
 Temporary splintage of the affected limb

Indications for Surgery


 Massive pus d/c
 Clinical & radiological evidence of one destruction + presence of sequestrum
 Brodie’s abscess

Surgery procedure
 Incision is made through the previous scar & sinus openings
 Drain out all soft t/s abscess
 Remove elevated periosteum + involucrum
 Drain subperiosteal pus
 If dead bone is seen  sequestrectomy
Ortho Eindra

 If Brodie’s abscess  remove the bony wall over the abscess ( saucerization )
 Wash the cavity with N/S & antiseptic solution
 Obliterate dead space by putting Antibiotics-impregnated beads
 Cover the cavity with m/s & temporary suturing of skin
 2wks later  wound exploration & cancellous bone graft done  Permanent
closure

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