Chronic osteomyelitis is a bone infection lasting over 6 weeks. It is characterized by recurrent inflammation, draining sinuses, and dead bone. Common causes are Staphylococcus aureus and other bacteria. Over time, the infection causes bone necrosis and formation of sequestra - dead bone pieces. Surgical treatment aims to thoroughly debride infected tissue, remove sequestra, and reconstruct the bone defect. Antibiotic therapy and soft tissue coverage are also important for treatment. Complications can include pathological fractures, deformity, and malignant transformation if not properly treated.
Chronic osteomyelitis is a persistent bone infection that can develop from acute osteomyelitis if the infection is not properly treated. It is characterized by the formation of dead bone (sequestra) surrounded by infected tissue. Treatment requires extensive surgical debridement to remove all infected and dead bone, followed by long-term antibiotics and procedures to fill dead space and promote healing. Complications can include continued infection, bone deformities, fractures and joint stiffness if not adequately addressed.
This document provides an overview of chronic osteomyelitis, including its definition, causative organisms, predisposing factors, pathology, clinical features, classification, diagnosis, treatment, and complications. Chronic osteomyelitis is a persistent bone infection that is usually caused by Staphylococcus aureus and often follows acute osteomyelitis or open fractures. It is characterized by infected dead bone surrounded by inflamed soft tissue. Treatment involves surgical debridement combined with long-term antibiotics to eliminate the infection. Complications can include exacerbations, growth abnormalities, fractures, and in rare cases, malignant transformation of the infected site.
This document provides an overview of giant cell tumor, a type of benign bone tumor. It discusses the definition, epidemiology, clinical presentation, investigations, grading, differential diagnosis, and treatment options. Giant cell tumor commonly involves the ends of long bones and is locally aggressive, destroying bone tissue. While benign, it can occasionally metastasize. Treatment typically involves curettage with the use of adjuvants like phenol or bone cement to reduce the high risk of recurrence. Reconstruction of residual defects is often done with bone grafts or cement.
Chronic osteomyelitis is difficult to treat and eradicate completely. It is characterized by infected dead bone within scarred soft tissue. Treatment requires long-term antibiotics as well as extensive surgical debridement to remove all infected and dead bone. Multiple surgical procedures may be needed to eliminate residual infection by removing bone sequestra and draining sinus tracts. Even with aggressive treatment, complications like reinfection, joint stiffness, and limb deformity are common.
1) Tuberculosis of the knee joint is the third most common site of osteoarticular tuberculosis, accounting for around 10% of skeletal tuberculosis cases.
2) Initial pathology involves hematogenous spread to the synovium or subchondral bone, forming tubercles. Advanced cases involve erosion of joint surfaces and destruction of bones.
3) Clinical features include knee swelling, warmth, effusion, tenderness, and restricted painful movement. Advanced cases develop triple deformity of flexion, adduction, and internal rotation.
The document summarizes a seminar on fracture healing and epiphyseal injuries. It discusses the stages of fracture healing in adults, including inflammation, soft callus formation, hard callus formation, and remodeling. It also discusses differences in fracture healing between cancellous and cortical bone. Additionally, it covers anatomy of the child bone, including the epiphysis, physis, metaphysis and diaphysis. It describes factors influencing bone growth and the phases of fracture healing in children. Finally, it discusses classification systems for epiphyseal injuries including Salter Harris, Poland, Aitken, and Peterson, as well as causes, evaluation, and treatment of physeal injuries.
Shoulder dislocation: Types and Management Methods of ReductionUzair Siddiqui
Shoulder dislocations have been depicted in Egyptian tomb art from 3000 BC. There are different types of shoulder dislocations including anterior, posterior, and inferior. Anterior dislocations are the most common. Clinical signs include pain, inability to contour the shoulder, and an anterior bulge. Radiographs can confirm and classify the dislocation. Reduction maneuvers include traction-countertraction, Hippocrates, Kocher, and scapular manipulation methods. Post-reduction, patients are immobilized and followed up to prevent recurrent dislocations, which occur in 50-90% of young patients.
This document outlines principles for managing malignant bone diseases. It discusses common primary bone tumors like osteosarcoma and metastases to bone from other cancers like breast and prostate. Diagnosis involves history, physical exam, imaging like x-rays and biopsy. Staging uses systems like Enneking and TNM. Treatment is usually multidisciplinary and may involve neoadjuvant chemotherapy, surgical resection with the goal of tumor-free margins, reconstruction of defects, and adjuvant therapies. Limb salvage surgeries aim to preserve function while achieving clear margins, though amputation may be needed in some cases. Prognosis depends on tumor type, stage, and response to treatment.
Chronic osteomyelitis is a persistent bone infection that can develop from acute osteomyelitis if the infection is not properly treated. It is characterized by the formation of dead bone (sequestra) surrounded by infected tissue. Treatment requires extensive surgical debridement to remove all infected and dead bone, followed by long-term antibiotics and procedures to fill dead space and promote healing. Complications can include continued infection, bone deformities, fractures and joint stiffness if not adequately addressed.
This document provides an overview of chronic osteomyelitis, including its definition, causative organisms, predisposing factors, pathology, clinical features, classification, diagnosis, treatment, and complications. Chronic osteomyelitis is a persistent bone infection that is usually caused by Staphylococcus aureus and often follows acute osteomyelitis or open fractures. It is characterized by infected dead bone surrounded by inflamed soft tissue. Treatment involves surgical debridement combined with long-term antibiotics to eliminate the infection. Complications can include exacerbations, growth abnormalities, fractures, and in rare cases, malignant transformation of the infected site.
This document provides an overview of giant cell tumor, a type of benign bone tumor. It discusses the definition, epidemiology, clinical presentation, investigations, grading, differential diagnosis, and treatment options. Giant cell tumor commonly involves the ends of long bones and is locally aggressive, destroying bone tissue. While benign, it can occasionally metastasize. Treatment typically involves curettage with the use of adjuvants like phenol or bone cement to reduce the high risk of recurrence. Reconstruction of residual defects is often done with bone grafts or cement.
Chronic osteomyelitis is difficult to treat and eradicate completely. It is characterized by infected dead bone within scarred soft tissue. Treatment requires long-term antibiotics as well as extensive surgical debridement to remove all infected and dead bone. Multiple surgical procedures may be needed to eliminate residual infection by removing bone sequestra and draining sinus tracts. Even with aggressive treatment, complications like reinfection, joint stiffness, and limb deformity are common.
1) Tuberculosis of the knee joint is the third most common site of osteoarticular tuberculosis, accounting for around 10% of skeletal tuberculosis cases.
2) Initial pathology involves hematogenous spread to the synovium or subchondral bone, forming tubercles. Advanced cases involve erosion of joint surfaces and destruction of bones.
3) Clinical features include knee swelling, warmth, effusion, tenderness, and restricted painful movement. Advanced cases develop triple deformity of flexion, adduction, and internal rotation.
The document summarizes a seminar on fracture healing and epiphyseal injuries. It discusses the stages of fracture healing in adults, including inflammation, soft callus formation, hard callus formation, and remodeling. It also discusses differences in fracture healing between cancellous and cortical bone. Additionally, it covers anatomy of the child bone, including the epiphysis, physis, metaphysis and diaphysis. It describes factors influencing bone growth and the phases of fracture healing in children. Finally, it discusses classification systems for epiphyseal injuries including Salter Harris, Poland, Aitken, and Peterson, as well as causes, evaluation, and treatment of physeal injuries.
Shoulder dislocation: Types and Management Methods of ReductionUzair Siddiqui
Shoulder dislocations have been depicted in Egyptian tomb art from 3000 BC. There are different types of shoulder dislocations including anterior, posterior, and inferior. Anterior dislocations are the most common. Clinical signs include pain, inability to contour the shoulder, and an anterior bulge. Radiographs can confirm and classify the dislocation. Reduction maneuvers include traction-countertraction, Hippocrates, Kocher, and scapular manipulation methods. Post-reduction, patients are immobilized and followed up to prevent recurrent dislocations, which occur in 50-90% of young patients.
This document outlines principles for managing malignant bone diseases. It discusses common primary bone tumors like osteosarcoma and metastases to bone from other cancers like breast and prostate. Diagnosis involves history, physical exam, imaging like x-rays and biopsy. Staging uses systems like Enneking and TNM. Treatment is usually multidisciplinary and may involve neoadjuvant chemotherapy, surgical resection with the goal of tumor-free margins, reconstruction of defects, and adjuvant therapies. Limb salvage surgeries aim to preserve function while achieving clear margins, though amputation may be needed in some cases. Prognosis depends on tumor type, stage, and response to treatment.
Osteomyelitis is an infection of bone and bone marrow that was coined in 1834 and refers to inflammation of bone. It can remain localized or spread through the bone. It is classified based on duration as acute, subacute, or chronic, and based on mechanism as hematogenous, exogenous, or by host response. Common causes are trauma, prosthetic devices, and immunocompromised states. Symptoms include fever, pain, and swelling. Diagnosis involves aspirating pus, blood tests, and imaging like x-ray, CT, or MRI. Treatment is based on antibiotics and possible surgery to debride infected tissue. Complications can include chronic infection, septic arthritis, and pathological fractures if not
Primary malignant bone tumors are rare cancers that can develop in bones. The accurate determination of the type and extent of the tumor is important for diagnosis and treatment planning. Imaging modalities like radiography, CT, and MRI play key roles in detecting bone tumors, determining their nature, assessing their size and spread, and monitoring patients over time. Different bone tumors are more common in different age groups and can originate from different areas of bones.
Tuberculosis of the hip joint is the second most common site of bone and joint TB after the spine. It typically affects people in their first three decades of life. The infection spreads from a primary focus such as the lungs to the hip joint via the bloodstream. It can initially involve different areas of the hip and pelvis before spreading to the joint. Patients present with hip pain, limping, and constitutional symptoms. Treatment involves anti-TB drugs along with rest, traction, and surgery if needed to address complications like joint destruction and deformity. Surgical options depend on the stage of disease and can include synovectomy, arthrodesis, osteotomy, or arthroplasty.
- A sequestrum is a separated, necrotic fragment of bone surrounded by infected tissue and pus. It acts as a nidus for bacteria to thrive.
- Sequestra come in different shapes, sizes, colors and consistencies depending on the underlying condition. Common types include pencil-like in infants and cylindrical in tuberculosis.
- Identifying sequestra involves injecting dyes like methylene blue which will stain live bone gray but leave dead bone blue. Removal of sequestra via sequestrectomy eliminates the infection and aids healing.
- Conditions that can mimic sequestra on imaging include radiation necrosis, bone tumors and mineralization of other lesions.
Bone tumour , enchondroma , osteochondromaSagar Savsani
The document provides information on neoplasia and the differences between benign and malignant tumors. It discusses the classification, clinical presentation, investigations, and radiographic evaluation of bone tumors. Some key points include:
- Benign tumors are usually encapsulated, compress surrounding tissue, and have low growth rates, while malignant tumors are poorly circumscribed, invade tissue, and have rapid growth rates.
- Bone tumors are classified based on the WHO system, site of origin, and Enneking's staging which considers grade, tumor size, and metastasis.
- Common presentations are pain, localized swelling, and laboratory findings such as elevated alkaline phosphatase. Imaging like x-rays help identify tumor location, borders, bone destruction
This document outlines principles of amputation, beginning with definitions and a brief history. It discusses indications for amputation including the 3 D's (dead, dying, or damn nuisance limb) and covers pre-operative, intra-operative, and post-operative principles and considerations. Complications are addressed as well as amputation in children. Prosthetics and rehabilitation goals are also summarized. The document provides an overview of best practices and factors to consider for successful amputation outcomes.
The document discusses different types of bone and joint infections including acute pyogenic osteomyelitis, subacute osteomyelitis, chronic osteomyelitis, and septic arthritis. It covers the classification, causative organisms, clinical presentation, investigations, treatment, and complications of each type of infection.
Bone tumors introduction and general principlesBarun Patel
This document discusses bone tumors. It covers the initial evaluation, presenting symptoms, history taking, physical examination, laboratory tests, investigations such as x-rays and scans, biopsy procedures and principles, classification, staging, principles of surgery including amputation vs limb salvage and achieving appropriate surgical margins, and treatment techniques such as curettage.
Imaging features of acute and chronic osteomyelitis are described in this PPT. Infective arthritis along with fungal infections of soft tissue are also covered very well. Special emphasis is given on tubercular infection of bone.
Approximately 5% of fractures result in non-unions and more in delayed unions. A delayed union occurs when healing is slower than average, between 3-6 months. Non-union is defined as no healing after 9 months. Factors contributing to delayed or non-union include systemic factors like nutrition, smoking, and local factors like soft tissue injury and fracture characteristics. Treatment involves addressing factors preventing healing, stabilizing the bone, bone grafting, and in some cases electrical or ultrasound stimulation to promote healing. Surgical techniques depend on the type and severity of the non-union.
This document summarizes information about giant cell tumors (GCT), including their history, definition, epidemiology, presentation, diagnosis and management. GCTs are benign bone tumors composed of stromal cells and multinucleated giant cells. They most commonly affect long bones of the extremities in patients aged 20-40. Diagnosis is made through imaging studies and biopsy. Treatment involves surgical curettage with or without adjuvants like phenol or liquid nitrogen. Wide excision or en bloc resection may be needed for more aggressive tumors.
Chronic osteomyelitis is a bone infection that has persisted for over 6 weeks. It is characterized by the formation of necrotic bone fragments called sequestrum. Symptoms are nonspecific but may include pain, swelling, and draining sinuses. Treatment involves surgical debridement of infected bone along with long-term antibiotics to address this difficult to treat infection that has high recurrence rates and causes significant bone and tissue damage over time.
This document discusses the management of infected nonunions of the tibia. It begins by defining a nonunion and describing the factors that can cause nonunions, including local factors like infection and systemic factors like smoking. It then discusses the microbiology of infected nonunions, classifying systems for infected nonunions, and challenges associated with infected nonunions like bone and soft tissue loss. Treatment involves thorough debridement to eradicate the infection, the use of local antibiotic delivery methods, and achieving bone union through methods like bone grafting, with the goals of managing infection, achieving bone healing, and restoring limb function.
Scapula fracture diagnosis and managementHemant Bansal
This document summarizes the diagnosis and management of scapula fractures. It discusses the anatomy, mechanisms of injury, classification systems, treatment indications, surgical approaches, complications, and recent literature. The key points are that scapula fractures often have associated injuries requiring evaluation, displacement or angulation greater than certain thresholds are indications for surgery, and internal fixation through a posterior approach typically yields good functional outcomes with low complication rates.
Giant cell tumor of bone is a locally aggressive bone tumor that typically affects young adults near the epiphysis of long bones. It appears lytic and expansile on imaging. Treatment has shifted from intralesional curettage, which has a high recurrence rate, to more extensive curettage with adjuvants like PMMA to fill the defect. For more advanced cases, en bloc resection is preferred but can require reconstruction. Close follow up is important due to the risk of local recurrence and rare pulmonary metastasis.
Unicameral Bone Cysts are fluid-filled bone lesions most common in children under 20. They form due to venous occlusion in the bone marrow and contain substances that cause bone resorption. Clinically, they present as swelling and pain after trauma in the femur or humerus. Radiographs show expanded thin bone with fractures. Treatment involves injections or surgery to curette the cyst membrane and fill the cavity to prevent fractures and recurrence.
Chronic Osteomyelitis, Bone infection slidesDiwakar Pratap
Chronic osteomyelitis is a bone infection lasting over 6 weeks characterized by recurrent inflammation, discharging sinuses, and dead bone. Staphylococcus aureus is the most common cause. Risk factors include inadequate treatment of acute osteomyelitis allowing it to become chronic. On imaging, dead bone (sequestra) is surrounded by sclerotic bone. Treatment involves surgical debridement of infected bone and tissue, followed by long-term antibiotics, bone grafts, or antibiotic beads to eliminate dead space and prevent recurrence. Complications can include exacerbation of infection, bone deformities, fractures, or joint stiffness.
This document provides information on chronic osteomyelitis, including types, pathology, diagnosis, and treatment. It notes that chronic osteomyelitis is usually caused by delayed or inadequate treatment of acute osteomyelitis, which allows spread of infection and bone death. Key features include sequestra (dead bone), involucrum (dense bone overlying sequestra), sinus tracts, and irregular thickened bone visible on x-ray. Treatment involves surgery to remove dead bone and tissue along with antibiotics to eliminate infection. Complications can include exacerbations, growth abnormalities, fractures, or rarely malignant changes in long-standing cases.
Osteomyelitis is an infection of bone and bone marrow that was coined in 1834 and refers to inflammation of bone. It can remain localized or spread through the bone. It is classified based on duration as acute, subacute, or chronic, and based on mechanism as hematogenous, exogenous, or by host response. Common causes are trauma, prosthetic devices, and immunocompromised states. Symptoms include fever, pain, and swelling. Diagnosis involves aspirating pus, blood tests, and imaging like x-ray, CT, or MRI. Treatment is based on antibiotics and possible surgery to debride infected tissue. Complications can include chronic infection, septic arthritis, and pathological fractures if not
Primary malignant bone tumors are rare cancers that can develop in bones. The accurate determination of the type and extent of the tumor is important for diagnosis and treatment planning. Imaging modalities like radiography, CT, and MRI play key roles in detecting bone tumors, determining their nature, assessing their size and spread, and monitoring patients over time. Different bone tumors are more common in different age groups and can originate from different areas of bones.
Tuberculosis of the hip joint is the second most common site of bone and joint TB after the spine. It typically affects people in their first three decades of life. The infection spreads from a primary focus such as the lungs to the hip joint via the bloodstream. It can initially involve different areas of the hip and pelvis before spreading to the joint. Patients present with hip pain, limping, and constitutional symptoms. Treatment involves anti-TB drugs along with rest, traction, and surgery if needed to address complications like joint destruction and deformity. Surgical options depend on the stage of disease and can include synovectomy, arthrodesis, osteotomy, or arthroplasty.
- A sequestrum is a separated, necrotic fragment of bone surrounded by infected tissue and pus. It acts as a nidus for bacteria to thrive.
- Sequestra come in different shapes, sizes, colors and consistencies depending on the underlying condition. Common types include pencil-like in infants and cylindrical in tuberculosis.
- Identifying sequestra involves injecting dyes like methylene blue which will stain live bone gray but leave dead bone blue. Removal of sequestra via sequestrectomy eliminates the infection and aids healing.
- Conditions that can mimic sequestra on imaging include radiation necrosis, bone tumors and mineralization of other lesions.
Bone tumour , enchondroma , osteochondromaSagar Savsani
The document provides information on neoplasia and the differences between benign and malignant tumors. It discusses the classification, clinical presentation, investigations, and radiographic evaluation of bone tumors. Some key points include:
- Benign tumors are usually encapsulated, compress surrounding tissue, and have low growth rates, while malignant tumors are poorly circumscribed, invade tissue, and have rapid growth rates.
- Bone tumors are classified based on the WHO system, site of origin, and Enneking's staging which considers grade, tumor size, and metastasis.
- Common presentations are pain, localized swelling, and laboratory findings such as elevated alkaline phosphatase. Imaging like x-rays help identify tumor location, borders, bone destruction
This document outlines principles of amputation, beginning with definitions and a brief history. It discusses indications for amputation including the 3 D's (dead, dying, or damn nuisance limb) and covers pre-operative, intra-operative, and post-operative principles and considerations. Complications are addressed as well as amputation in children. Prosthetics and rehabilitation goals are also summarized. The document provides an overview of best practices and factors to consider for successful amputation outcomes.
The document discusses different types of bone and joint infections including acute pyogenic osteomyelitis, subacute osteomyelitis, chronic osteomyelitis, and septic arthritis. It covers the classification, causative organisms, clinical presentation, investigations, treatment, and complications of each type of infection.
Bone tumors introduction and general principlesBarun Patel
This document discusses bone tumors. It covers the initial evaluation, presenting symptoms, history taking, physical examination, laboratory tests, investigations such as x-rays and scans, biopsy procedures and principles, classification, staging, principles of surgery including amputation vs limb salvage and achieving appropriate surgical margins, and treatment techniques such as curettage.
Imaging features of acute and chronic osteomyelitis are described in this PPT. Infective arthritis along with fungal infections of soft tissue are also covered very well. Special emphasis is given on tubercular infection of bone.
Approximately 5% of fractures result in non-unions and more in delayed unions. A delayed union occurs when healing is slower than average, between 3-6 months. Non-union is defined as no healing after 9 months. Factors contributing to delayed or non-union include systemic factors like nutrition, smoking, and local factors like soft tissue injury and fracture characteristics. Treatment involves addressing factors preventing healing, stabilizing the bone, bone grafting, and in some cases electrical or ultrasound stimulation to promote healing. Surgical techniques depend on the type and severity of the non-union.
This document summarizes information about giant cell tumors (GCT), including their history, definition, epidemiology, presentation, diagnosis and management. GCTs are benign bone tumors composed of stromal cells and multinucleated giant cells. They most commonly affect long bones of the extremities in patients aged 20-40. Diagnosis is made through imaging studies and biopsy. Treatment involves surgical curettage with or without adjuvants like phenol or liquid nitrogen. Wide excision or en bloc resection may be needed for more aggressive tumors.
Chronic osteomyelitis is a bone infection that has persisted for over 6 weeks. It is characterized by the formation of necrotic bone fragments called sequestrum. Symptoms are nonspecific but may include pain, swelling, and draining sinuses. Treatment involves surgical debridement of infected bone along with long-term antibiotics to address this difficult to treat infection that has high recurrence rates and causes significant bone and tissue damage over time.
This document discusses the management of infected nonunions of the tibia. It begins by defining a nonunion and describing the factors that can cause nonunions, including local factors like infection and systemic factors like smoking. It then discusses the microbiology of infected nonunions, classifying systems for infected nonunions, and challenges associated with infected nonunions like bone and soft tissue loss. Treatment involves thorough debridement to eradicate the infection, the use of local antibiotic delivery methods, and achieving bone union through methods like bone grafting, with the goals of managing infection, achieving bone healing, and restoring limb function.
Scapula fracture diagnosis and managementHemant Bansal
This document summarizes the diagnosis and management of scapula fractures. It discusses the anatomy, mechanisms of injury, classification systems, treatment indications, surgical approaches, complications, and recent literature. The key points are that scapula fractures often have associated injuries requiring evaluation, displacement or angulation greater than certain thresholds are indications for surgery, and internal fixation through a posterior approach typically yields good functional outcomes with low complication rates.
Giant cell tumor of bone is a locally aggressive bone tumor that typically affects young adults near the epiphysis of long bones. It appears lytic and expansile on imaging. Treatment has shifted from intralesional curettage, which has a high recurrence rate, to more extensive curettage with adjuvants like PMMA to fill the defect. For more advanced cases, en bloc resection is preferred but can require reconstruction. Close follow up is important due to the risk of local recurrence and rare pulmonary metastasis.
Unicameral Bone Cysts are fluid-filled bone lesions most common in children under 20. They form due to venous occlusion in the bone marrow and contain substances that cause bone resorption. Clinically, they present as swelling and pain after trauma in the femur or humerus. Radiographs show expanded thin bone with fractures. Treatment involves injections or surgery to curette the cyst membrane and fill the cavity to prevent fractures and recurrence.
Chronic Osteomyelitis, Bone infection slidesDiwakar Pratap
Chronic osteomyelitis is a bone infection lasting over 6 weeks characterized by recurrent inflammation, discharging sinuses, and dead bone. Staphylococcus aureus is the most common cause. Risk factors include inadequate treatment of acute osteomyelitis allowing it to become chronic. On imaging, dead bone (sequestra) is surrounded by sclerotic bone. Treatment involves surgical debridement of infected bone and tissue, followed by long-term antibiotics, bone grafts, or antibiotic beads to eliminate dead space and prevent recurrence. Complications can include exacerbation of infection, bone deformities, fractures, or joint stiffness.
This document provides information on chronic osteomyelitis, including types, pathology, diagnosis, and treatment. It notes that chronic osteomyelitis is usually caused by delayed or inadequate treatment of acute osteomyelitis, which allows spread of infection and bone death. Key features include sequestra (dead bone), involucrum (dense bone overlying sequestra), sinus tracts, and irregular thickened bone visible on x-ray. Treatment involves surgery to remove dead bone and tissue along with antibiotics to eliminate infection. Complications can include exacerbations, growth abnormalities, fractures, or rarely malignant changes in long-standing cases.
This document discusses chronic osteomyelitis, including its causes, symptoms, diagnosis, and treatment. It defines chronic osteomyelitis as a persistent bone infection caused by bacteria that form biofilms and evade the host immune system and antibiotics. Diagnosis involves imaging tests like X-ray, CT, MRI, and PET scans to identify dead bone fragments (sequestra) and determine the infection's extent. Treatment requires extensive surgical debridement to remove all infected and dead bone, along with long-term antibiotics and management of any underlying health issues predisposing to infection.
Osteomyelitis is an infection of bone and bone marrow that can spread locally or systemically. It is classified based on duration into acute (<2 weeks), subacute (2 weeks-3 months), and chronic (>3 months) forms. Mechanisms of infection include hematogenous spread, direct inoculation, or contiguous spread. Common causative organisms are Staphylococcus aureus and gram-negative rods. Diagnosis involves clinical features, lab findings like elevated inflammatory markers, and imaging studies showing bone changes over time. Treatment consists of antibiotics, surgery to debride infected bone, and measures to promote bone healing.
Osteomyelitis is an infection of bone and bone marrow that was coined in 1834 and includes three root words - osteon, myelo, and itis. It may remain localized or spread through the bone. It is classified based on duration as acute (<2 weeks), subacute (2 weeks to 3 months), or chronic (>3 months). Three basic mechanisms allow infection to reach bone: hematogenous spread, contagious source, or direct implantation. Symptoms include fever, fatigue, and localized swelling, erythema, and tenderness. Diagnosis involves aspirating pus for smear and culture, blood tests like ESR and CRP, and imaging like x-rays, CT, or MRI
Osteomyelitis is an infection of bone and bone marrow that was coined in 1834 and includes three root words - osteon, myelo, and itis. It may remain localized or spread through the bone. There are three main mechanisms of infection - hematogenous spread, direct contact, and direct implantation. Osteomyelitis is classified based on duration as acute (<2 weeks), subacute (2 weeks to 3 months), or chronic (>3 months). Diagnosis involves clinical features, lab findings like elevated WBC and ESR, and radiological findings like periosteal reaction visible on x-rays after 1-2 weeks. Treatment involves antibiotics, surgery to debride infected tissue, and management of complications
osteomyelitis-Types, clinic features and treatment.pptxPraveen Yadav
1. Osteomyelitis is an infection of bone and bone marrow that is usually caused by bacteria. It can be acute, subacute, or chronic depending on duration of symptoms.
2. It is commonly caused by hematogenous spread of bacteria from another infected site like skin, lungs, or throat to the bone marrow. Direct implantation from open fractures or surgery is another mechanism.
3. Symptoms include fever, pain, and swelling near the infected bone. Diagnosis involves blood tests, imaging like x-rays, CT, or MRI to identify bone changes, and aspirating fluid for culture. Treatment involves long-term antibiotics and possible surgery to remove infected bone.
Chronic osteomyelitis is a bone infection that often develops after trauma or surgery and can become long-lasting. It is caused by bacteria like Staphylococcus aureus entering bone via trauma, implants, or poor circulation. Chronic osteomyelitis is characterized by bone necrosis, inflammatory reaction, abscess formation, and reactive new bone growth forming an involucrum around dead bone (sequestrum). Treatment involves long-term antibiotics combined with surgical debridement of infected and dead tissue, possible bone grafting, and soft tissue coverage to fully clear the infection.
This document provides information about osteomyelitis, including:
1) Osteomyelitis is an inflammation of bone caused by an infecting organism that may remain localized or spread through the bone. Common causes are bacteria or fungi entering through a break in the skin or spreading via blood.
2) It can be classified as acute (less than 2 weeks), subacute (2-6 weeks), or chronic (over 6 weeks) based on duration of symptoms. It can also be classified based on mechanism of infection such as exogenous (from outside trauma/surgery) or hematogenous (from another infectious site).
3) Staphylococcus aureus is the most common pathogen. Risk factors
This document provides an overview of chronic osteomyelitis. It begins with definitions and describes the pathogenesis as bacteria reaching the metaphysis, causing inflammation and tissue necrosis. Imaging can detect bone changes like lytic lesions. Diagnosis involves biopsy for culture and histology. Chronic osteomyelitis is characterized by infected dead bone (sequestrum) surrounded by sclerotic bone (involucrum) that forms draining sinus tracts. Multiple organisms are often present and biofilm formation complicates treatment. Differential diagnosis includes tuberculosis, soft tissue infection, and tumors.
Chronic osteomyelitis is difficult to treat and eradicate completely. It is characterized by infected dead bone within soft tissue with poor blood supply, making systemic antibiotics ineffective. Surgical debridement of infected bone and soft tissue is usually required along with long-term antibiotics. Eliminating dead space after debridement can be challenging and may require bone grafting, antibiotic beads, or flaps to fill gaps and promote healing.
Acute and Chronic Osteomyelitis - Infection of BoneRahul Singh
Osteomyelitis is an inflammatory process of bone caused by bacterial infection. It can be acute, subacute, or chronic depending on duration and host response. Common causes are Staphylococcus aureus and trauma. Acute osteomyelitis presents with fever, pain, and swelling near the infected bone in children. Treatment involves antibiotics and surgical drainage. Chronic osteomyelitis results from inadequate treatment of acute infection and is characterized by persistent sinus tracts and bone destruction. Surgical debridement along with long-term antibiotics is usually required to treat chronic osteomyelitis.
Osteomyelitis is an inflammatory process of bone and bone marrow caused by a bacterial infection. It can be acute, subacute, or chronic depending on the duration of infection. Acute osteomyelitis most commonly affects children and is usually caused by Staphylococcus aureus in the metaphysis of long bones. Chronic osteomyelitis results from inadequate treatment of acute osteomyelitis and is characterized by persistent infection, bone necrosis, sinus tract formation, and bone destruction seen on imaging. Treatment involves long-term antibiotics and surgical debridement to remove infected bone. Physical therapy focuses on restoring range of motion, strength, and mobility while protecting the infected bone during recovery.
This document discusses bone and joint infections, specifically osteomyelitis. It covers the classification, causative organisms, presentation, imaging findings, complications, and types of osteomyelitis such as Brodie's abscess, Garre's sclerosing osteomyelitis, and suppurative spondylitis. Staphylococcus aureus is responsible for over 90% of cases. Imaging plays an important role in diagnosis, with MRI being the most sensitive test. Complications can include chronic osteomyelitis, pathological fractures, and joint involvement.
This document discusses bone and joint infections, specifically osteomyelitis. It covers the classification, causative organisms, presentation, imaging findings, complications, and types of osteomyelitis such as Brodie's abscess, Garre's sclerosing osteomyelitis, and suppurative spondylitis. Staphylococcus aureus is responsible for over 90% of cases. Imaging plays an important role in diagnosis, with MRI being the most sensitive test. Complications can include chronic osteomyelitis, pathological fractures, and joint involvement.
This document discusses and classifies acute and subacute osteomyelitis. It begins by defining osteomyelitis as a bone or bone marrow infection. It then classifies osteomyelitis based on timing of onset (acute <2 weeks, subacute 2-6 weeks, chronic >6 weeks) and method of spread (exogenous or hematogenous). Key points include: acute osteomyelitis most commonly spreads hematogenously while staphylococcus aureus is the most common cause; subacute osteomyelitis has an indolent course and is often an incidental finding on imaging. Treatment involves antibiotics, surgery if abscess or lack of response, and immobilization.
Here are the answers to your questions:
1. Most common site of osteomyelitis - Metaphysis of long bones, especially distal femur and proximal tibia.
2. Most common organism causing osteomyelitis - Staphylococcus aureus.
3. Earliest radiographic and MRI findings of acute osteomyelitis - Soft tissue swelling and loss of fascial planes seen within 24-48 hours on radiographs. Bone marrow edema seen as low signal on T1 and high signal on T2/STIR sequences in MRI.
4. What is sequestrum - Avascular/necrotic bone fragment formed due to osteonecrosis in chronic osteomyelitis
Septic arthritis is an infection of a joint that causes inflammation. It occurs when bacteria or other microorganisms spread through the bloodstream from another infected site in the body and enter the joint space. Common symptoms include pain, swelling, warmth and reduced range of motion in the infected joint. Diagnosis involves synovial fluid analysis, blood tests and imaging. Treatment requires intravenous antibiotics and may also involve surgical drainage and debridement of the joint. Complications can include bone and cartilage destruction, joint fibrosis or ankylosis if not treated promptly.
This document provides an overview of prosthetics and orthotics. It defines prosthetics as the replacement of missing body parts and orthotics as devices that support, align, or correct deformities of movable body parts. The document describes various types of prosthetics and orthotics for the upper and lower limbs, including components, materials, and designs. It also discusses indications and functions for different orthotic devices used in the cervical, thoracic, and lumbar spine regions.
This document discusses recent advances in using ceramics in orthopaedics. It describes different types of ceramics used, including bioinert, bioactive, and bioresorbable ceramics. Bioinert ceramics like alumina and zirconia are used in joint replacements due to their strength and wear resistance. Bioactive ceramics like hydroxyapatite bond with bone and are used in bone grafts and coatings. Bioresorbable ceramics like calcium phosphates degrade and are replaced by bone. Applications include joint replacements, coating implants, and filling bone defects. The excellent biocompatibility of ceramics has encouraged their use in orthopaedics
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Three sentence summary:
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2. INTRODUCTION
Chronic osteomyelitis is an infection of bone and marrow of more than six weeks
duration characterised by recurrent attacks of inflammation with discharging
sinuses and presence of infected dead bone(sequestra).
Causes: pyogenic bacteria, mycobacteria, or fungus but the term usually indicate
pyogenic infection.
5. An acute becomes
chronic due to one of the
following reasons:
1. Improper drainage of
the pus in acute
osteomyelitis
2. Formation of an
undrained non
collapsable cavity in
the bone
6. 3. Presence of sequestra
4. Presence of foreign
bodies in case of
osteomyelitis following
open injuries
9. PATHOGENESIS
Infection at the bone locus
creates an increase of
intramedullary pressure as a
result of inflammatory
exudate stripping the
periosteum; this leads to
vascular thrombosis, followed
by bone necrosis and the
10. Usually, necrosis of the
large segments of bone
leads to sequestrum
formation. These
sequestra with infected
material are surrounded
by sclerotic bone that is
relatively avascular.
11. The haversian canals are
blocked with scar tissue, and
the bone is surrounded by
thickened periosteum and
scarred muscle
Antibiotics cannot penetrate
these relatively avascular
tissues and are hence
ineffective in clearing the
12. New bone formation occurs at
the same time (involucrum)
around the dead bone
Multiple openings appear in
this involucrum, (cloacae)
through which exudates and
debris from the sequestrum
pass via the sinuses.
14. Sequestrum:
It is a piece of dead bone
separated from healthy
bone. The area of dead
bone gets demarcated by
granulation tissue and
gradually separates and
forms a loose piece of
sequestrum.
15. Types of sequestrum-
1) corraliform- in pyogenic
infections
2) ivory sequestrum –
syphillis
3) feathery sequestrum- in
tuberculosis of long
bones
16. 4) sand sequestrum – in
vertebral tuberculosis
5) black sequestrum – in
fungal infections
6) ring sequestrum – in pin
tract infections and
amputation stumps
17. CLINICAL FEATURES
Presentation-
Unlike acute
osteomyelitis, chronic
osteomyelitis causes
no acute
constitutional
symptoms
The presenting
features may be those
of a long-standing,
discharging sinus or
chronic bone pain that
persists despite
treatment.
18. Patients may also
present with acute
exacerbations and
usually have a
history of acute
osteomyelitis,
sometimes dating
back to childhood.
Some times it may
present with a
pathological
19. On examination
drainage of pus
and small
sequestra through
the skin sinus is
found which is the
hall mark of
chronic
osteomyelitis.
23. Laboratory blood
studies are nonspecific
and gives no indication
of severity of infection.
ESR and CRP are
elevated in most
patients but WBC is
elevated only in 35%
24. DIAGNOSIS CONT..
X ray usually
shows bone
resorption with
thickening and
Sclerosis of the
surrounding
bone. A cavity
may appear as
an osteolytic
area.
28. DIAGNOSIS CONT..
M.R.I – More useful
for soft tissue
evaluation. It also
shows areas of bony
edema. It reveal an
area of high signal
intensity
surrounding the
active disease (rim
sign). Sinus tracts
also appears as
areas of increased
29. DIAGNOSIS CONT..
Isotope bone
scanning –
technetium 99m bone
scans which shows
increased uptake in
areas of increased
blood flow or
osteoblastic activity
but tend to lack
specificity. It has a
30. Gallium scan – show
increased uptake in areas of
leukocyte or bacteria
accumulation. A normal
gallium scan virtually
excludes osteomyelitis and
can be useful as follow up
examination.
31. Indium 111-labled leucocyte
scan- Specially useful to
differentiate chronic
osteomyelitis from reactive
bone disease or neuropathic
arthropathy.
Biopsy with culture
sensitivity – It is the gold
standard for establishing
diagnosis.
34. TREATMENT CONT.
Aims are –
1) adequate debridement
2) appropriate
reconstruction of bone and
soft tissue defect
3) appropriate antibiotic
therapy
35. SURGICAL TREATMENT
Sequestrectomy and
curettage – The
infected area of bone
is exposed and all
sinus tracks
completely excised.
The indurated
periosteum is incised
and elevated on both
sides. Drill is used to
outline a cortical
window at the
36. SURGICAL TREATMENT CONT
Remove all sequestra,
purulent material,
scarred and necrotic
tissue. If sclerotic
bone seals off a cavity
within medullary
canal, open it on both
directions to allow
blood vessels to grow
37. SURGICAL TREATMENT CONT
After removing
all suspicious
matter excise the
over hanging
edges of bone
and avoid leaving
are dead space.
38. SURGICAL TREATMENT CONT.
PAPINEAU technique-
this procedure is based
on following principles-
1) Granulation tissue
markedly resist
infection.
2) Autogenous
cancellous bone grafts
are rapidly
revascularized and are
resistant to infection.
39. SURGICAL TREATMENT CONT.
The operation is divided
into three stages-
a)excision of infected
tissue with or without
stabilization using an
external fixator or
intramedullary rod.
Dressing continued till
healthy appearing
granulation tissue is
40. SURGICAL TREATMENT CONT.
b)Cancellous bone
grafting in concentric
and overlapping layers
c)Wound coverage- in
some cases spontanous
epithelialization results,
otherwise skin grafts,
myocutaneous flaps or
muscle pedicle flaps can
be used.
41. SURGICAL TREATMENT CONT.
POLYMETHYLMETHAC
RYLATE(PMMA)
antibiotic bead chains-
the rationale for this
treatment is to deliver
high level of antibiotics
locally in
concentrations that
exceed the mic. The
antibiotic is leached
from beads into the
postoperative wound
hematoma and
secretion.
42. SURGICAL TREATMENT CONT.
Before the beads
are implanted the
infected and dead
tissue should be
debribed. the
beads are
implanted in the
bony defect.
43. SURGICAL TREATMENT CONT.
Aminoglycosides are
most commonly used,
but cephalosporins
and vancomycin also
used. Short term (10
days), long term (6
weeks), or permanent
implantation is
possible. The limb
should be
appropriately
44. SURGICAL TREATMENT CONT
Biodegradable Antibiotic
Delivery systems – Various
biodegradable antibiotic
delivery systems have been
evaluated. The main
advantage to these is that a
second procedure is not
required to remove the
implant.
45. SURGICAL TREATMENT CONT
Furthermore, some of these
biodegradable substrates
contain calcium, which can be
used in new bone formation. As
these beads resorb they are
slowly replaced by new bone
and soft tissue, and this process
may decrease the need for
further reconstructive or
coverage procedures.
46. SURGICAL TREATMENT CONT.
Soft Tissue Transfer – Soft
tissue transfers to fill dead
space left behind after
extensive debridement may
range from a localized muscle
flap on a vascular pedicle to
microvascular free tissue
transfer.
47. SURGICAL TREATMENT CONT.
The transfer of vascularised
muscle tissue improves the
local biological environment
by bringing in a blood
supply that is important in
the host’s defence
mechanisms, as well as for
antibiotic delivery and
osseous and soft tissue
48. SURGICAL TREATMENT CONT.
Most commonly a local muscle
flap is used in the treatment
of chronic osteomyelities of
the tibia. The gastrocnemius
muscle is used for defects
about the proximal third, and
soleus muscle is used for
defects at middle third.
49. SURGICAL TREATMENT CONT.
Ilizarov Technique – the
Ilizarov technique has been
helpful in the treatment of
chronic osteomyelitis and
infected non unions. This
technique allows radical
resection of the infected
bone.
50.
51. SURGICAL TREATMENT CONT.
A corticotomy is performed
through normal bone proximal
and distal to the area of
disease. The bone is
transported until union is
achieved.
Disadvantages include the time
required to achieve a solid
union and the high incidence of
52. SURGICAL TREATMENT CONT.
Hyperbaric Oxygen Therapy –
Hyperbaric oxygen therapy
has not proved to be reliably
effective. The use of
hyperbaric oxygen can be
recommended only as an
adjuvant to more traditional
methods of treatment.
55. BRODIE ABSCESS
A Brodie abscess is a
localized form of
subacute
osteomyelitis that
occurs most often
in the long bones of
the lower
extremities of
young adults.
Before physeal
closure, the
56. In adults the
metaphyseal-
epiphyseal area is
involved.
Intermittent pain
of long duration is
the presenting
complaint, along
with local
tenderness over
the affected area.
57. On plain roentgenograms a
Brodie abscess generally
appears as a lytic lesion with a
rim of sclerotic bone but can
have a markedly varied
appearance
Careful evaluation of plain films is
mandatory because a Brodie
abscess can be easily mistaken
for a variety of neoplasm
The lesion is thought to be
caused by organisms of low
virulence. S. aureus is cultured
in 50% of patients, in 20%
culture is negative.
58. This condition often
requires an open biopsy
with curettage to make
the diagnosis. The
wound should be closed
loosely over a drain.
59. GARRE’S OSTEOMYELITIS
Sclerosing Osteomyelitis of Garre –
Sclerosing osteoyemilitis is a
chronic from of disease in which
the bone is thickened and
distended but abscesses and
sequestra are absent
The disease affects children and
young adults
Its cause is unknown, but it is
thought to be an infection caused
by a low-grade, possibly anaerobic
60. Patients report intermittent
pain of moderate intensity
and usually of long duration.
Swelling and tenderness over
the affected bone may be
found
Roentgenograms show an
expanded bone with
generalized sclerosis
The ESR usually is slightly
elevated
Biopsy shows only chronic,
low-grade, nonspecific
61. A secondary lesion at a distant
site can occur years after
onset. No treatment has been
predictably helpful, but
fenestration of the sclerotic
bone and antibiotics are
advisable
The condition must be
distinguished from osteoid
62.
63. SALMONELLA OSTEOMYELITIS
Subacute type of
osteomyelitis usually
occurring in the ulna, ribs,
and vertebrae
Occurs some months or
years after attack of typhoid
or paratyphoid fever
Commonly associated with
sickle cell anaemia
64. Presents as an abscess
within the diaphysis of
bone
Blood widal tests may be
positive
Biopsy and culture
sensitivity done to
establish diagnosis.
Surgery is always required.
65. FUNGAL (MYCOTIC) INFECTION
Mycotic osteomyelitis is
the general term used to
describe a group of
diseases caused by
fungal infections of bone
There are two main
organisms- Actinomyces
and Maduramyces.
66. FUNGAL (MYCOTIC) INFECTION
Actinomycosis from cattle, occurs in
man in the soft tissues like mouth,
appendix, caecum and lung. Bone
affected secondarily, mandible most
commonly. The infection may spread
from lung to thoracic spine and from
caecum to pelvis. Multiple abscesses
result with the typical amorphous
yellow granules or sulphur granules
formed of fungal colonies.
67. FUNGAL (MYCOTIC) INFECTION CONT.
The affected bone has a
moth-eaten appearance. In
the spine the condition is
distinguished from
tuberculosis by sparing of
intervertebral discs and
absence of vertebral
collapse and kyphosis. The
heads of ribs and
transverse processes are
68. FUNGAL (MYCOTIC) INFECTION CONT.
Treatment is classically with the
penicillins, addition of
streptomycin or tetracycline
may be necessary. Antibiotic
should be continued for 6
month at least. Surgical
excision of the affected bone is
required for treatment of
69. MADURA FOOT:
~ first described by
Gill in 1832 from
madurai. The
organism usually
enter through a cut
in the foot, from
there they spread
through
subcutaneus tissue
and tendon sheaths.
Bones infected by
direct invasion
Patient may present
at early stage with
tender
70. ~ as the condition
forms tumour like
mass it was called
mycetoma
~ Swelling
gradually spreads
and blister forms
which ultimately
involves the whole
foot. X ray shows
multiple bony
cavities or
progressive bone
destruction.
71. ~ It later bursts
and forms
multiple
discharging
sinuses
~ pus contains
black granules
which are fungal
colonies from
which organism
can be isolated.
72. ~ Treatment :
1.penicillin or
dapsone orally
may be
effective but
usually
unsatisfactory,
i.v.
amphotericin B
is advocated
which is fairly
toxic.
74. TUBERCULOUS OSTEOMYELITIS
Tuberculous dactylitis
~ occurs in children and young
adults
~ infection starts in the shaft of the
phalanx and causes erosion and
gradual destruction of the bone
~ subperiosteal new bone
formation and thickening of bone
this phenomenon is peculiar to
the tuberculous infection in the
75. ~The surrounding
soft tissue also swell
up and cold abscess
often forms and
bursts to form
chronic sinuses
~ the patient
presents with a
painful spindle
shaped swelling of
finger which is called
spinosa ventosa
76. SYPHILITIC OSTEOMYELITIS
Syphilitic affections of bone occur in
the inherited and acquired forms of
the disease and in the latter they are
more serious in the tertiary stage.
They differ from tuberculus
affections in that the shaft is more
frequently involved while the joints
escape
The causative organism is Treponema
pallidum
The tibia, femur and humerus and the
cranial bones are most common
sites of syphilitic osteomyelitis.
77. SYPHILITIC OSTEOMYELITIS CONT.
Manifestations –
1. Pain – this may vary from slight
dull ache to most excruciating
pains. There are no local
abnormalitis on clinical exam. and
a diagnosis of neuralgia is often
made.
2. Periostitis – frequently occurs and
affects multiple long bones.
3. The periosteal node – the
characteristic lesion is a localized
swelling of shaft which usually
involves a portion of the
circumference, and may surround
78. 1. Diffuse osteoperiostitis – this
is a chronic inflammation
affecting the whole bone or
the greater portion of it inside
the periosteal envelope.
X-ray shows double outline
which is very characteristic. A
second sheath of compact
bone surrounds the original
compact layer but an
intervening space exists
which may be filled with
granulation tissue.
79. 2. Syphilitic osteochondritis –
children with inherited
syphilis show an irregularity
of the epiphyseal line. This
irregularity is due to
transformation of cartilage
into bone. There is
thickening of epiphysis and
pain on passive movement.
80. 3. Gummatous
Osteomyelitis - Gumma
can occur on surface of
the bone or within it. The
surface gumma
resembles an ordinary
periosteal nod except that
its speedily softens at its
centre. A gumma is in the
interior of long bone is a
serious condition as it is
mistaken for a malignant
81. 4. Syphilitic dactylitis – the
importance of syphilis of the
phalanges lies in the fact that it
may be mistaken for
tuberculosis. But there is little
tendency to break down and
ulcerate as in tuberculosis. The
condition is usually painless.
Antibiotics are usually
ineffective. Pathological
fracture from break down of
gamma needs stabilization.