These slides describe osteomyelitis and its surgical/therapeutic treatment and how to diagnose it clinically and by investigations.

1. OSTEOMYELITIS Hamzeh Yacoub

2. OSTEOMYELITIS OVERVIEW
The primary sites of infection are bone and bone
marrow.
Any part of a bone may be involved but there is
preferential targeting of the metaphyseal regions
of long bones adjacent to joints (because of the
rich but slow blood flow of the growing bone and
deficiency of phagocytic cells)
The risk of osteomyelitis increases with age.
If untreated, the condition may cause localised
areas of osteonecrosis, leading to the development
of a fragment of necrotic bone that is called a

4. PATHOGENESIS
Haematogenous spread is the most common
cause in children. Vertebrae is the most
hematogenous cause in adults.
Contiguous spread of infection from adjacent
soft tissues in adults eg; Diabetic foot ulcers.
Direct implantation of microbes via
penetrating injuries, Open fractures, Surgeries.

5. CLASSIFICATION OF
OSTEOMYELITIS
Acute: within 2 weeks.
Subacute: within one – 3 months.
Chronic: after 3 months.
The pathologic features of osteomyelitis are:
The Prescence of necrotic tissue (sequestrum)
 formation of new bone (involucrum )

6. CIERNY-MADER CLASSIFICATION
3 types of patients and 4 types of bone
infections.
Types of patients:
A) Healthy
B) Compromised (locally, systemically).
C) Severe systemic compromised (treatment is
worse than the infection itself).

7. CIERNY-MADER CLASSIFICATION
Types of bone infections:
I. Medullary.
II. Superficial.
III. Localized defect with stable bone.
IV.Diffuse infection and instable bone.

8. CIERNY-MADER CLASSIFICATION

9. RISK FACTORS FOR
OSTEOMYELITIS
DM
Immunosuppressive therapy.
HIV.
Dialysis.
IV drug use, pseudomonas is common.
Malnutrition
Sickle cell disease; increases risk of Salmonella
infection however S.Aureus is the most common.

10. CLINICAL FEATURES
Localized bone pain.
Tenderness.
Malaise, night sweats, Fever.
The adjacent joint may be painful to move and
may develop a sterile effusion or secondary
septic arthritis.

11. HOW TO DIAGNOSE ?
MRI is more sensitive than X-ray for detecting
early changes (7-14 days lag).
Where possible, cultures should be obtained
by open or imaging guided biopsy of the lesion.
Blood cultures should be taken, which may
also reveal the causative organism.
Serum labs reveals high CRP and ESR.
Note: only 50% of MSK infections have high
inf. Markers.

12. DIFFERENTIAL DIAGNOSIS
In children Eosinophilic granuloma, Ewing’s
Sarcoma and Acute osteomyelitis may resemble
each other, the patient may also have fever,
pain, tenderness, increased ESR, leuckocytosis.
It can be also can be confused with healing
fracture, or a benign or malignant tumor.
Biopsy is crucial for the diagnosis.

13. SURGICAL TREATMENT
Treatment of osteomyelitis is usually a
combination of surgical debridement of the
necrotic tissue, and administration of culture
specific antibiotics.
Remove the involucrum  remove the
sequestrum  saucerize the bone external
fixation for stabilization  fill the cavity with
cement  IV antibiotics for 6 weeks according
to the culture.

14. MRSA OSTEOMYELITIS
4 criteria if exist 92% chance of having MRSA:
1) Body temperature more than 38.
2) WBCs count more than 12.000/mm3
3) Hematocrit less than 34%
4) CRP more than 13
Higher incidence of DVT than all other causes of
osteomyelitis.
Treated with Vancomycin or Clindamycin.
Valentine leucocidin gene in MRSA strains