Acute osteomyelitis is a bone infection commonly caused by Staphylococcus aureus, primarily affecting the metaphysis of long bones, particularly in children. Diagnosis is based on clinical symptoms and supportive investigations, while treatment involves early antibiotic administration and potentially surgical intervention for abscess drainage if symptoms persist beyond 48 hours. Complications may include chronic osteomyelitis and septic complications, with prevention focusing on proper management of open fractures.

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  responsible 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

10. • 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
– Abscess in the muscle or subcutaneous plane (later stages)
– There may be swelling of the adjacent joint

11. • 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):
• May show increased uptake by the
bone in the metaphysis (positive
before changes appear in x-ray)

12. • Differential diagnosis:
a) Acute septic arthritis
b) Acute rheumatic arthritis
c) Scurvy
d) 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

13. • 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

14. • 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

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

16. 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

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