The document discusses bone infection or osteomyelitis, including causes such as bacterial infection spreading through the bloodstream or nearby tissue, symptoms like fever and bone pain, diagnosis through tests like blood work, x-rays and biopsies, and treatment involving long-term antibiotic therapy and sometimes surgery to drain infections and remove damaged tissue. Osteomyelitis can affect people of all ages but is more common in infants, children, and older adults.

1. SEMINAR ON
INFECTION OF BONE
PRESENTED BY
om verma

2. DEFINITION
 a bone. Infections can reach a bone by
traveling through the bloodstream or
spreading from nearby
tissue. Infections can also begin in
the bone itself if an injury exposes
the bone to germs. In children,
osteomyelitis most commonly affects the
long bones of the legs and upper

4. SKELETAL SYSTEM
The skeletal system comprises the bony framework of
the body. It consist of 206 individual bones in the adult.
Some bones are hinged and others are focused to one
another.
FUNCTIONS:-
 > It supports body structure and provide shape to the
body
 > It protects the soft and delicate internal organs
 >It allows movement and anchorage of muscles .
 > It provides mineral storage
 > It is the site for hemopoiesis

5. STRUCTURE AND FORMATION OF
BONES
Bone consist of microscopic cells called “osteocytes”
(from the Greek word osteon,meaning bone”) .An
osteocyte is a mature bone cell. Bone is made up
of 35% organic material,65%in organic mineral
salts and water
 .A typical long bone consist of the following
parts:-
 The diaphysis (growing between)is the bones
shaft or body the long
 The epiphyses (growing over ) are the distal ends
of the bone

7. CONT………………………..
 The metaphyses (meta- between ) are the regions
in a mature bone where the diaphysis joins the
epiphyses.
 The articular cartilage it is a thin layer of
hyaline cartilage covering the epiphysis where
the bone forms an articulation(joint) with
another bone.
 The periosteum (around ) is a tough sheath of
dense irregular connective tissue that surrounds
the bone surface whenever it is not covered by
articular cartilage
 The medullary cavity (marrow or marrow cavity)
is the space within the diaphysis that contains
fatty yellow bone in

8. CONT…………….
 The Endosterm is a thin membrane that lines the
medullary cavity.
BLOOD AND NERVE SUPPLY
 Bone is richly supplied with blood .Blood
vessels ,which are specially abundant in portion
of bone containing red bone marrow pass into
bones from the periosteum.

9. INFECTION :-
 The term infection is used to denote an
inflammatory process caused by disease
producing organisms

10. SEPTIC ARTHRITIS:-
 Septic arthritis (also known as pyogenic arthritis
infection arthritis, septic joint disease ,bacterial
arthritis ,and suppurative arthritis) is a closed
space- infection caused by invasion of synovial
membrane by pus forming bacteria or other
pathogens.

11. CONT……………
 The presence of septic arthritis typically reflect:-
 The failure of multiple defense mechanism .In
the early stage of infection
 The synovial membrane swells and becomes
infiltrated with neutrophils
 A purulent effusion distends the joint as the
neutrophils release lysosomal proteolytic
enzymes that destroy the articular cartilage
,subchondrial bone, and joint capsule.
 Enzymatic cartilage destruction can actually
occur in 3 to 24 hours.

12. ASSESMENT FOCUS ON :-
 Diagnostic procedures.
 IV drug abuse.
 Systemic disease
 Initial laboratory studies
MANAGEMENT:-
 Antibiotic therapy is a critical part of effective
treatment of septic arthritis
 Open synovectomy and debridement or repeated joint
aspiration and irrigation may be performed
 Anthroscopic drainage and debridement have also
been successful

13. OSTEOMYELITIS
 Osteomyelitis is an inflammation or swelling of bone
tissue that is usually the result of an infection.
Osteomyelitis, or bone infection, may occur for many
different reasons and can affect children or adults
 Some of the causes of osteomyelitis include the
following
 Osteomyelitis may occur as a result of a bacterial
bloodstream infection, sometimes called bacteremia,
or sepsis, that spreads to the bone.
 Osteomyelitis can also occur from a nearby infection
due to a traumatic injury, frequent medication
injections, a surgical procedure, or use of a
prosthetic device.

14. CONT…………
 Individuals with weakened immune systems are more
likely to develop osteomyelitis
 Osteomyelitis can affect all populations from infants
and children to the elderly. It is more common in
infants, children, and older adults. Populations at
increased risk include individuals with weakened
immune systems, recent trauma, or diabetes.

15. Contiguous-focus OsteomyelitisContiguous-focus Osteomyelitis
Clinical setting:Clinical setting:
Postoperative infectionPostoperative infection
Contamination of boneContamination of bone
Contiguous soft tissue infectionContiguous soft tissue infection
Puncture woundsPuncture wounds

16. Contiguous-focus OsteomyelitisContiguous-focus Osteomyelitis
Microbiologic featuresMicrobiologic features
STAPHYLOCOCCISTAPHYLOCOCCI  AUREUS, EPIDERMIDISAUREUS, EPIDERMIDIS
GRAM-NEGATIVE BACTERIAGRAM-NEGATIVE BACTERIA
ANAEROBIC INFECTIONANAEROBIC INFECTION
UNUSUAL ORGANISMSUNUSUAL ORGANISMS CLOSTRIDIA, NOCARDIACLOSTRIDIA, NOCARDIA

17. HEMATOGENOUS OSTEOMYELITISHEMATOGENOUS OSTEOMYELITIS
Clinical manifestationClinical manifestation
Classic presentation: Sudden onsetClassic presentation: Sudden onset
Usually presentation: Slow, insidiousUsually presentation: Slow, insidious
High fever, Night sweatsHigh fever, Night sweats
Fatigue, Anorexia, Weight lossFatigue, Anorexia, Weight loss
Restriction of movementRestriction of movement
LOCAL EDEMA, ERYTHEMA, & TENDERRNESSLOCAL EDEMA, ERYTHEMA, & TENDERRNESS

18. HEMATOGENOUS OSTEOMYELITISHEMATOGENOUS OSTEOMYELITIS
Microbiologic featuresMicrobiologic features
StaphylococciStaphylococci  Aureus, EpidermidisAureus, Epidermidis
StreptococciStreptococci  Group A & BGroup A & B
Haemophilus influenzaeHaemophilus influenzae
Gram-negative enteric bacilliGram-negative enteric bacilli
AnaerobesAnaerobes
PolymicrobialPolymicrobial
MycobacterialMycobacterial
FungiFungi

19. HEMATOGENOUS OSTEOMYELITISHEMATOGENOUS OSTEOMYELITIS
Special considerationSpecial consideration
Sickle cell diseaseSickle cell disease
Injection drug users (IDUs)Injection drug users (IDUs)
HemodialysisHemodialysis
HIV/AIDSHIV/AIDS
ImmunosuppressionImmunosuppression
Prosthetic orthopedic deviceProsthetic orthopedic device

20. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Micro organisms enter boneMicro organisms enter bone
(Phagocytosis).(Phagocytosis).
Phagocyte contains the infectionPhagocyte contains the infection
Release enzymesRelease enzymes
Lyses boneLyses bone

21. CONTD…………..
Pus spreads into vascular channelsPus spreads into vascular channels
Raising intraosseous pressureRaising intraosseous pressure
Impairing blood flowImpairing blood flow
Chronic ischemic necrosisChronic ischemic necrosis
Separation of large devascularized fragmentSeparation of large devascularized fragment
New bone formationNew bone formation
(involucrum)(involucrum)

22. THE SYMPTOMS OF
OSTEOMYELITIS?
 Fever (the fever may be high when osteomyelitis occurs as
the result of a blood infection)
 Pain and tenderness in the affected area
 Irritability
 Feeling ill
 Swelling of the affected area
 Redness in the affected area
 Warmth in the affected area
 Difficulty moving joints near affected area
 Difficulty bearing weight or walking
 A new limp
 A stiff back (with vertebral involvement)

23. HOW IS OSTEOMYELITIS
DIAGNOSED
 Blood tests
 Complete blood count (CBC)
 Erythrocyte sedimentation rate (ESR)
 Reactive protein (CRP)
 Needle aspiration or bone biopsy
 X-ray –
 Radionuclide bone scans
 Computed tomography scan (Also called CT or CAT
scan.)
 Magnetic resonance imaging (MRI
 Ultrasound -

25. TREATMENT FOR
OSTEOMYELITIS:
 your age, overall health, and medical history
 extent of the condition
 your tolerance for specific medications, procedures, and therapies
 expectation for the course of the condition
 your opinion or preference
 Medications
Administration of intravenous (IV) antibiotics, which may require
hospitalization or may be given on an outpatient schedule, may be
necessary. Intravenous or oral antibiotic treatment for osteomyelitis
may be very extensive, lasting for many weeks.
 Monitoring of successive x-rays and blood tests
 Pain management
 Bed rest or restricted movement of the affected area
 Surgery
In some cases, surgical intervention may be necessary to drain
infectious fluid, or to remove damaged tissue and bone.

26. LONG-TERM CONSIDERATIONS FOR
OSTEOMYELITIS:
Osteomyelitis requires long-term care to
prevent further complications, including
care to prevent the following:
fractures of the affected bone
stunted growth in children (if the
infection has involved the growth plate)
gangrene infection in the affected area

27. SPECIFIC CLINICAL CONDITIONS:-
 VERTERBRAL OSTEOMYELITIS:-
 Vertebral osteomyelitis is most frequently of the
hematogenous type and usually involves the lower
dorsal and lumbar spine, occasional involvement
of the cervical spine has described
 OSTEOMYELITIS IN OTHER UNUSUAL
LOCATIONS:-
 Involvement of the sternoclavicular joint are has
been described intravenous drug abuses and in
patient with in dwelling intravenous devices.

28. ANAEROBIC OSTEOMYLITIS:-
Osteomylitis due to anaerobic organisms has been
described in a variety of clinical situation
OSTEOMYELITIS IN SICKLE CELL
ANEMIA:-
 Patients with homozygous sickle cell disease
who under all circumstances are subject to serve
salmonella infection often suffer from
osteomyelitis due to this organisms

29. CONT………….
 OSTEOMYELITIS IN DRUG ADDICTS:-
 Septic arthritis and osteomyelitis of long bones
are frequently found in drug addicts
 TUBERCULOSIS:-
 Osteomyelitis of long bones due to
mycobacterium tuberculosis has become a rarity
in industrialized countries but still has been
considered in patient with the combination of
localized bone destruction ,fistula and negative
bone cultures.

30. CONT……………
 BRODIE ABSCESS:-
Brodie abscess is characterized
by bone pain, low grade fever if
any, and a radio graphic pictures
of a central destruction and
rounded by sclerosis.75% of
cases occur in the lower
extremities ,

31. CONT………..
When conservative modalities fail to
control the infection ,surgical
intervention is indicated .Many
types of surgery are possible from
simple debridements to amputation.
Nursing Management of the patient
with osteomyelitis include the
following

32.  Use Aseptic technique during dressing
changes.
 Observing the patient for signs and
symptoms of systematic infection.
 Encouraging range of motion exercise to
prevent contractures ,and flexion
deformities.
 Administering antibiotics on time as
prescribed.
 Administering analgesics and /or
antipyretics as prescribed and monitoring
patient for effectiveness.
 Promoting rest of affected joint or limb

33. CONTD……………
 NURSING PRIORITIES:-
Bone pain.
Fever.
Nausea and Malaise.
Alteration in elimination.
Knowledge deficit.
Coping pattern.
Image disturbance.