Acute osteomyelitis - A short Review Acute osteomyelitis is the clinical term for a new infection in bone. This infection occurs predominantly in children and is often seeded hematogenously. In adults, osteomyelitis is usually a subacute or chronic infection that develops secondary to an open injury to bone and surrounding soft tissue

1. Dr Abu Shuraih Sakhri

2. Introduction
 Infection of bone by micro-organisms is called OSTEOMYELITIS
 Acute osteomyelitis can be primary (haematogenous) or
secondary (following a fracture)
 Haematogenous or the primary is commonest and is often
seen in children

3. Metaphysis of long bones
 it is a highly vascularised zone
 Vessels in this zone are arranged in loop which result in blood
stasis
 This results in metaphysis being the favourite site for bacteria
to settle
 in most joints, metaphysis is extra articular but in some joints
they are intra articular and this result in developing spread of
infection to joint resulting pyogenic arthritis

4. Aetiopathogenesis
 causative organism is Staphylococcus aureus (commonest)
 Other organisms : streptococcus & pneumococcus
 Primary focus is generally not detectable
 The host bone initiates an inflammatory response
 Leads to bone destruction and production of pus
 Its spreads through
 Along medullary cavity: trickle through medullary cavity causing thrombosis of
medullary vessels
 Out of the cortex: pus travels along the Volkmann’s canal. The periosteum is
lifted off the underlying bone, resulting damage to periosteal blood supply.
Eventually the periosteum is perforated letting the pus out
 In other directions: spread to joint if metaphysis is intra articular

5. Diagnosis
 Symptoms:
 Acute onset of pain and swelling at the end of the bone associated with fever
 A history of injury may be present
 Examination:
 Febrile, dehydrated
 Signs of inflammation localised to metaphysis of bone
 In later stages there may be swelling of adjacent joints because of sympathetic
effusion or arthritis
 Investigation
 Blood: leucocytosis and elevated ESR
 X-ray: earliest sign is periosteal new bone formation
 Bone scan: using Technetium 99 show increased uptake by the bone

6. Differential Diagnosis
 Acute septic arthritis
 Acute rheumatic arthritis
 Scurvy
 Acute poliomyelitis

7. Treatment
 if the patient is brought within 48hrs of onset of symptoms
 rest, antibiotics and general building up of patient
 In children less than 4 months of age: Ceftriaxone and Vancomycin
 In older children: Ceftriaxone and Cloxacillin
 Rehydrate the child with adequate iv fluids
 If the signs diminishes, then the limb can be mobilised
 Weight bearing is restricted for 6-8 weeks
 If the patient doesn’t respond within 48 hrs of starting treatment,
surgical intervention is required

8.  if the patient brought after 48hrs of onset of symptoms
 Detection of pus is difficult in clinical examination so a USG is done
 Surgical exploration and drainage is the mainstay of treatment in this
stage
 Antibiotics and rehydration are continued post operatively

9. Complications
 General complications
 Septicaemia
 pyaemia
 Local complications
 Chronic osteomyelitis
 Acute pyogenic arthritis
 Pathological fracture
 Growth plate disturbances

10. Thank You