Osteomyelitis - Orthopaedics

Osteomyelitis - Orthopaedics

It is an infection of bone.
-Vertebrae are the most commonly bones in adults.
-And in childrens long bones are affected.

 common causative organisms

s. aureus
streptococci
h. influenzae
p. aeruginosa
salmonella

pathophysiology

Once the bacteria enters the bone tissue, they bind to the host tissue and starts to produce the polysaccharide extracellular matrix.

  • In chronic cases: infection leads to devascularization of affected bone and then necrosis and resorption of surrounding bone- leading to sequestrum.
*sequestrum: floating piece of dead bone*

  • Involucrum means a layer of new bone growth might also form after sequestrum.
the region will be encased in a thick sheath of periosteal new bone.

RISK FACTORS

[mnemonic- DIE]
  • Diabetes mellitus                                                                                        
  • Immuno-suppressions(like aids or long term use of steroids)            
  • Excessive intake of alcohol                                                                       

CLINICAL FEATURES

  • Severe constant pain
  • Low grade pyrexia
  • On examination- the site will be tender, swelling, erythema.


DIFFERENTIAL DIAGNOSIS

  • Trauma injury 
  • Septic arthritis
  • Primary or secondary bone tumors

Potts disease: it is an infection of the vertebral body and intervertebral disc by mycobacterium tuberculosis.


INVESTIGATIONS

  • Routine blood tests like FBC, CRP, ESR
  • Blood cultures
  • Radiographs
  • MRI imaging
  • Bone biopsy is the gold standard diagnosis

MANAGEMENT

  1. If patient is well and not clinically weak: long term intravenous antibiotic therapy is given.
  2. If patient is clinical ill, surgical intervention is needed .

COMPLICATONS

  • Sepsis and mortality if not treated well 
  • Soft tissue infections may occur 
  • Premature physeal closure in childrens
  • Recurrence of infection
  • Chronic osteomyelitis in immuno-compromised patients, under-treated patients, virulent

CHRONIC OSTEOMYLITIS

  • It presents with localized bone pain 
  • Non specific infections like malaise, lethargy
  • Blood test shows normal inflammatory markers and negative blood cultures

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