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. BRODIES 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
FAILS TO THRIVE IRRITABLE LESS CONSTITUTIONAL SYMPTOMS

INFANTS

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 GAUCHERS 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 cepholosporin Second generation cepholosporin(cefuroxime) Older children and Adults
Majority have staphylococcal infection Flucloxacin and fusidic acid

 Sickle cell disease

salmonella or other gram neg organisms third generation ceph or quinolone Elderly and Unfit patients greater than usual risk of gram neg infection flucloxacin plus third generation ceph Immunocompromised unusual 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 PROPHYLAXIS IN ESTABLISHED CASES DEBRIDEMENT DRAINAGE REPEATED WOUND EXISIONS REMOVAL 0F LOOSE IMPLANTS USE EXTERNAL FIXATION OTHERWISE KEEP IMPLANT TILL UNION

POST. OPERATIVE OSTEOMYELITIS

EARLY WITHIN 03 MONTHS SUPERFICIAL DEEP BOTH
FOLLOWING EARLY COVERT INFECTION FOLLOWING A LONG COARSE OF NORMALCY

LATE

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 BETTER THAN UNSTABLE SEPTIC FRACTURE
SO KEEP THE IMPLANT TILL UNION OR CONVERT TO EXTERNAL FIXATION