Osteomylitis

1. OSTEOMYELI
TIS

2. DEFINITION
 Osteitis: a general term for inflammation of
the bone
 Osteomyelitis is a severe pyogenic infection
and inflammation of bone and surrounding
tissues

3. CLASSIFICATION
Based on mode of entry – classified in to
 Exogenous osteomyelitis
 Endogenous or hematogenous osteomyelitis
Based on the duration
 Acute and chronic ostoemyelitis

4. Exogenous osteomyelitis
 Onset is insidious
 Infection begins in soft tissues, disrupting muscle
and connective tissue and eventually forming
abscess
 Caused by a pathogen outside the body or by the
spread of infection from adjacent soft tissues.
 Example – from an open fracture or a surgical
procedure, can also caused by human and animal
bites
 The infection spreads from soft tissues to the bone

6. Hematogenous osteomyelitis
 Caused by blood borne pathogens originating
from infectious sites within the body
 Example –from sinus, ear, dental, respiratory
and genitourinary infections
 In this the infection spreads from the bone to
the soft tissues and eventually break through
the skin becoming draining fistula
 More common in children's and older adults

8. RISK FACTORS
 Soft tissue infections and direct bone
contamination (surgery, gunshot)
 Chronic illness
 Diabetes or vascular disease
 Alcohol or drug abuse
 Immunosuppression
 Elderly
 Poorly nourished
 Obese patients

9. ETIOLOGY
 Bacteria
 Viruses
 Fungi and parasites
 Common microorganisms are S.aureus,
streptococcus, hemophilus influenzae
enterobacteria, salmonella
 Entry of organism from an open wound or
hematogenous spread

10. PATHOPHYSIOLOGY
In hematogenous osteomyelitis
 Organisms reach the bone through the circulatory
and lymphatic systems
 Bacteria lodge in the small vessels of the bone
 Inflammation
 Blockage of the vessel causes thrombosis, ischemia
and necrosis of bone
(femur, tibia, humerus and radius are commonly

11. Bacteria and inflammation spread within the shaft of the
bone and spread throughout the haversian systems
and reach the periosteum
Subperiosteal abscess
Segmental bone necrosis sequestrum (dead piece of
bone)
new bone laid down over the infected bone by
osteoblasts is called as involucrum- opening in the
involucrum allow infected material to escape into soft
tissue

12. CLINICAL FEATURES
 Acute osteomyelitis – less than one month in
duration
 CM of acute osteomyelitis are both systemic and
local
 Systemic – fever, night sweats, chills,
restlessness, nausea and malaise
 Local – severe bone pain unrelieved by rest and
worse with activity, swelling, tenderness, warmth
at the site
 Later signs include drainage from sinus tracts to
the skin and fracture site

13. Clenched fist
osteomyelitis

15. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Lab studies - elevated WBC, c-reactive protein (CRP)
and erythrocyte sedimentation rate (ESR)
 BLOOD CULTURE – to find out the organisms
 CT scan and radionuclide bone scan
 X ray ,MRI, Bone biopsy

16. MANAGEMENT
Goals
 Complete removal of dead bone and affected
soft tissue
 Control of infection
 Elimination of dead space

17. SURGICAL MANAGEMENT
Debridement surgery
 To remove necrotic tissue
 Removal of sequestrum and surrounding
granulation tissue (sequestrectomy)
 The dead space is later filled with, antibiotic
beads (polymethylmethacrylate beads with either
vancomycin, tobramysin or gentamicin),tissue
flaps and bone grafts
 Beads are usually removed after 2 to 4 weeks and
reconstruction is performed

21. Osteomyelitis with fracture
 Bone graft and internal or external fixation
together
 Ilizarov technique – helps in bone lengthening
and reshaping.
 Papineau technique - type of open bone
grafting technique in which wounds are
packed with cancellous bone with no attempt at
soft tissue coverage.

24. COMPLICATIONS
 Sepsis
 Pathologic fracture and non
union
 Draining fistula
 Shortening of the extremity
 Amputation
 Brodie’s abscesses –
isolated encapsulated
pockets of microorganisms
surrounded by bone matrix –
capable of reinfection at any

25. MEDICAL MANAGEMENT
 Antipyretics and analgesics
 Antibiotic therapy – penicillin, cephalosporin,
Clindamycin
 Depends on the causative organism
 2 to 4 weeks IV followed by 4 weeks oral
medication
 3 to 6 weeks in case of orthopedic implants
 Hyperbaric oxygen therapy may be used

26. NURSING MANAGEMENT
 Maintain aseptic technique during dressing
 Observes for signs and symptoms of
complications
 Timely medication – for effective action of
antibiotics
 Complete rest for early healing
 Fracture prevention
 Use splints and other assistive devices
 ROM exercises to prevent contractures and
functional deformities
 Provide diet high in vitamins and proteins

27. NURSING DIAGNOSIS
 Acute pain
 Impaired physical mobility
 Activity intolerance
 Risk for fracture
 Deficient knowledge

28. Relieving pain
 Restrict activity
 Immobilize affected part – use splints
 Handle affected part with care
 Elevate affected part to reduce swelling and
discomfort
 Administer prescribed analgesic
 Monitor neurovascular status of affected
extremity

29. Controlling infectious process
 Monitor response of treatment
 Observe IV sites for phlebitis or infiltration
 If surgery is planned, ensure adequate
circulation
 Maintain aseptic technique
 Avoid pressure on grafted area
 Monitor general health
 Provide a balanced diet high in protein and
vitamin C to promote healing

30. Home and community based
care
 Self care
 Strict therapeutic regimen of antibiotics
 Prevention of falls
 Teach patient how to maintain and manage the IV
access site and equipment it there
 Provide medical education (drug name, dose,
frequency and administration)
 Instruct patient to observe for elevated temp, drainage,
adverse reactions
 Teach patient and family how to perform aseptic
dressing
 Explain the importance of follow up