Acute Osteomyelitis

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• Acute Osteomyelitis

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Infection in bone

• Osteomyelitis
• acute (subacute)
• chronic
• specific (eg TB)
• non specific(most common)

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Acute haematogenous OM

• mostly children
• boysgt girls
• history of trauma

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Acute OsteomyelitisOrganism

• Gram ve
• staphylococus aureus
• strep pyogen
• strep pneumonie
• Gram -ve
• haemophilus influnzae (50 lt 4 y)
• e .coli
• pseudomonas auroginosa,
• proteus mirabilis

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Acute Osteomyelitis Source Of Infection

• infected umbilical cord in infants
• boils, tonsilitis, skin abrasions
• in adults UTI, in dwelling arterial line

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Acute Osteomyelitis

• Source of Infection
• Hematogenous
• Direct spread
• Exogenous

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Acute Osteomyelitis Pathology

• starts at metaphysis
• ?trauma
• vascular stasis
• acute inflammation
• suppuration
• necrosis
• new bone formation
• resolution

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Acute Osteomyelitis

• Pathology
• Primary focus and stage of inflammation
• Spread of infection with pus formation
• Formation of subperiosteal abscess
• Pus tracks toward skin to form a sinus
• Bone infarction (Sequestrum)
• New bone formation (involucrum)

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Acute Osteomyelitis
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Acute Osteomyelitis
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Acute Osteomyelitis

• Age variation
• Neonates
• Extensive bone necrosis
• Increased ability to absorb large sequestrum
• Increased ability to remodel
• Epiphysio-metaphyseal vascular connection leading
  to secondary septic arthritis

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Acute Osteomyelitis Clinical Features

• severe pain
• reluctant to move
• fever
• malaise
• toxemia

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Acute Osteomyelitis

• Clinical Pictures
• History
• Skin lesion
• Sore throat
• Trauma

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Acute Osteomyelitis

• Clinical Pictures
• Symptoms
• Pain, restless
• Malaise and fever
• The limb is held still (pseudo paralysis)
• Sometimes mild or absent (neonates)

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Acute Osteomyelitis

• Clinical Pictures
• Signs
• General and Local
• Laboratory Tests
• CBC
• ESRCRP
• Blood culture (ve in 50-70)
• Aspiration (Gram stain culture and sensitivity)

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Acute Osteomyelitis Infant

• failure to thrive
• drowsy
• irritable
• metaphyseal tenderness
• decrease ROM
• commonest around the knee

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Acute Pyogenic Osteomyelitis

• Age variation
• Adults
• No subperiosteal abscess due to adherent
  periosteum
• Soft tissue abscess
• Vascular connection with the joint leading to
  secondary septic arthritis

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Acute OsteomyelitisAdult

• commonly thoracolumbar spine
• fever
• backache
• history of UTI or urological procedure
• old ,diabetic ,immunocompromised

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Acute Osteomyelitis Diagnosis

• History and clinical examination
• FBC, ESR, B.C.
• X-ray (normal in the first (10-14) days
• Ultrasound
• Bone Scan Tc 99, Gallium 67
• MRI
• Aspiration

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Acute Osteomyelitis

• Radiography
• Plain X-ray
• Ultrasound
• Bone gallium scan (Sensitive but not specific)
• CT scan
• MRI

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Acute Osteomyelitis
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Acute Osteomyelitis

• Differential Diagnosis
• Acute Septic Arthritis
• Acute monoarticular rheumatoid arthritis
• Sickle cell crisis
• Cellulitis
• Ewings Sarcoma

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Acute Osteomyelitis

• Treatment
• Antibiotics
• Type?
• Route?
• When to start?
• When to stop
• Monitoring?

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Acute Osteomyelitis

• Treatment
• Surgical Drainage
• Indications?
• Procedure?
• Drilling?

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Acute Osteomyelitis

• Treatment
• General
• Hospitalization
• Hydration
• Electrolyte replacement
• Analgesia
• Immobilization

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Acute Osteomyelitis Treatment

• supportive treatment for pain and dehydration
• splintage
• antibiotics
• surgery

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Acute OsteomyelitisTreatment

• Antibiotics Start blindly after taking blood
  culture.
• Older child previously fit adults.(staph inf)
  I/V flucloxacillin and fusidic acid. 2-3 wks.
  Then orally 3-6 wks.
• Child under 4 (haemophilus inf.) Cefuroxime or
  cefotaxime or co-amoxiclav.
• Immunocompromised pts Third generation
  cephalosporins.

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Acute OsteomyelitisTreatment

• Neonates and infants up to 6 months of age
  penicillin-resistant Staphylococcus aureus,
  Group B streptococcus and Gram-negative
  organisms.
• flucloxacillin plus a third-generation
  cephalosporin like cefotaxime.
• Children 6 months to 6 years of age Haemophilus
  influenzae. combination of intravenous
  flucloxacillin and cefotaxime or cefuroxime.

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Acute OsteomyelitisTreatment

• Elderly and previously unfit patients,
  Gram-negative infections, combination of
  flucloxacillin and a second- or third-generation
  cephalosporin.
• Heroin addicts and immunocompromised patients
• Unusual infections (e.g. with Pseudomonas
  aeruginosa,
• Proteus mirabilis or anaerobic Bacteroides
  species)
• third-generation cephalosporins or a
  fluoroquinolone
• preparation, depending on the results of
  sensitivity tests.

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Acute OsteomyelitisTreatment

• Drainage
• CF do not improve within 36 Hrs.
• Signs of deep pus.( swelling, oedema,
  fluctuation).
• If pus is aspirated.

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Acute Osteomyelitis Complications

• septicemia
• metastatic infection
• septic arthritis
• altered bone growth
• chronic osteomyelitis

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Acute Osteomyelitis

• Prognosis
• Factors affecting prognosis
• Organisms
• Infected Bone
• Age of the Patient
• Treatment

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Subacute OsteomyelitisClinical features

• long history (weeks, months)
• pain, limp
• swelling occasionally
• local tenderness

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Subacute OsteomyelitisPathology

• Brodies abscess
• a well defined cavity
• in cancellous bone

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Subacute OsteomyelitisInvestigation

• X ray
• Bone scan
• Biopsy(50) grow organism

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Subacute OsteomyelitisTreatment

• antibiotics for 6 months
• surgery