Acute osteomyelitis

basics about osteomyelitis.
p/s: some helpful slides are copied from http://www.slideshare.net/group7usmkk/osteomyelitis-7739286

1. ACUTE OSTEOMYELITIS NUR HANISAH ZAINOREN

2. OSTEOMYELITIS ACUTE CHRONIC PRIMARY SECONDARY HEMATOGENOUS FOLLOWING AN OPEN FRACTURE/ BONE OPERATION Infection of the bone by pyogenic micro-organisms

3. Highly vascularized zone Venous system begins in this area and drains towards the diaphysis Vessel are arranged in the form of hair-pin arrangement  blood stasis  r esponsible for the metaphysis being the favourite site for bacteria  osteomyelitis METAPHYSIS OF LONG BONE

4. TYPES OF METAPHYSIS

5. AETIOPATHOGENESIS Staph. aureus  commonest causative organisms Others: Streptococcus & Pneumococcus Reach the bone via blood circulation Lodged in the metaphysis Lower femoral metaphysis *commonest Upper femoral metaphysis Upper tibial metaphysis Upper humeral metaphysis

6. Disease of CHILDHOOD , more common in BOYS , probably because they are more prone to injury Diagnosis is clinical Presenting complaints: Pain Swelling Fever Chills and rigor Examination: Febrile and dehydrated Red, hot, tender, swelling, edema A bscess in the muscle or subcutaneous plane (later stages) There may be swelling of the adjacent joint

7. Investigations: Blood: PMN leucocytosis Elevated ESR Blood culture at the peak of the fever may yield the causative organism X-rays: Earliest sign (7-10 days): periosteal new bone deposition at the metaphysis (periosteal reaction) Bone scan (Technetium-99): M ay show increased uptake by the bone in the metaphysis (positive before changes appear in x-ray)

8. Differential diagnosis: Acute septic arthritis Acute rheumatic arthritis Scurvy Acute poliomyelitis *Any acute inflammatory disease at the end of a bone, in a child, should be taken as acute osteomyelitis unless proved otherwise. *Any history of trauma, must be thoroughly questioned

9. Treatment: Within 48 hours of the onset of symptoms Pus not yet formed and the inflammatory process can be halted by systemic antibiotics Consists of rest , antibiotics and general building-up of the patient Rest - Limb is put to rest in a splint or by traction Antibiotics - choices varies depend on the age of the child & choice of the doctor General – rehydration with IV fluids, weight bearing restriction for 6-8 weeks

10. Treatment: After 48 hours of the onset of symptoms Child is brought late or does not respond to conservative treament  Collection of pus within or outside the bone Detection of pus by ultrasound examination (because it may lie deep to the periosteum) Surgical exploration and drainage Antibiotics are continued for 6 weeks

11. Complications: General complications: Septicaemia Pyemia Local complications: Chronic osteomyelitis Acute pyogenic arthritis Pathological fracture Growth plate disturbances

12. SECONDARY OSTEOMYELITIS Arises from a wound infection in an open fractures or after operations on the bone Less severe than hematogenous osteomyelitis (as wound provide some drainage) Prevention: adequate initial treatment of open fractures adherence to sterile operating conditions

13. THANK YOU :)