basics about osteomyelitis. p/s: some helpful slides are copied from http://www.slideshare.net/group7usmkk/osteomyelitis-7739286

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

17. THANK YOU :)