Osteomyelitis

1. Infections in Bone & Joints
Topics
1. Osteomyelitis
2. Septic Artheritis
Dr. Ruwanka De Livera

2. Parts of long bones

3. 1. Osteomyelitis
Can be 1. acute (subacute)
2. chronic
1. Introduction
Most commonly Haematogenous spread
mostly children
boys> girls
history of trauma

4. 2.Source Of Infection
 1. infected umbilical cord in infants
 2. boils, tonsilitis, skin abrasions
 3. in adults UTI, in dwelling arterial line

5. 3. Organism
 1. Gram +ve
 1.staphylococus aureus (most common)
 2.strep pyogen
 3.strep pneumonie
 2. Gram -ve
 1.haemophilus influnzae (50% < 4 y)
 2.e .coli
 3.pseudomonas auroginosa,
 4.proteus mirabilis

6. 4. Pathology
 starts at metaphysis
 ?trauma
 vascular stasis
 acute inflammation
 suppuration
 necrosis
 new bone formation
 resolution

7. Acute Osteomyelitis

8. 5. Clinical Features
 1. severe pain
 2. reluctant to move
 3. fever
 4. malaise
 5. toxemia fts

9. Clinical fts - Infant
 1. failure to thrive
 2. drowsy
 3. irritable
 4. metaphyseal tenderness
 5. decrease ROM
 *commonest around the knee

10. 6. Diagnosis
 History and clinical examination
 1. FBC, ESR, CRP, B.C.
 2. X-ray (normal in the first (10-14) days
 3. Ultrasound
 4. Bone Scan Tc 99, Gallium 67
 5. MRI
 6. Aspiration

11. 7. Treatment
 1. supportive treatment for pain and dehydration
 2. splintage
 3. Antibiotics
 4. surgery

12. 8. Complications
 1. septicemia
 2. metastatic infection
 3. septic arthritis
 altered bone growth
 chronic osteomyelitis