Acute osteomyelitis is a bacterial infection of bone that mainly affects children. It is classified based on duration (acute, subacute, chronic) and route of infection (primary/hematogenous, secondary). Staphylococci and streptococci are common causes. Clinical features include pain, fever and localized tenderness. Diagnosis involves imaging like bone scans and MRI. Treatment consists of supportive care, splinting, appropriate antibiotics based on patient factors, and surgical drainage if abscess is present. Complications can include impaired bone growth and chronic osteomyelitis if not treated properly.

1. Acute
Osteomyelitis
Amalina Aminuddin
082012100067

2. • Infection of bone
• Mainly affect children
Introduction

3. Predisposing factors
• Malnutrition and
general debility
• Diabetes mellitus
• Corticosteroid
administration
• Immunosuppressive
drugs
• Venous stasis in the
limb
• Peripheral vascular
disease
• Loss of sensibility
• Iatrogenic invasive
measures
• Trauma

4. • Based on duration:
• Acute (< 2 weeks )
• Subacute (2-3 weeks )
• Chronic ( > 3 weeks )
• Based on route of
infection:
• Primary(hematogenou
s)
• Secondary
• Based on organism
• Pyogenic:
Staphylococci,
Streptococcus,
Pneumococci,
Gonococci, H.
influenza ,Kingella
kingae E. coli,
Salmonella sp,
• Non pyogenic:
tuberculosis, syphilis,
Classifications

5. Pathogenesis
Children
• Hairpin loops  stasis
• Low oxygen tension
• Structure in the
hypertrophic zone of the
physis

7. Infants
• anastomoses between
metaphyseal and
epiphyseal vessels

8. Adults
• Direct spread
from infection
foci
• Local trauma
• Hematogenous

9. Pathology
• Depend on:
• Patient’s age
• Site of infection
• Virulence of the
organism
• Host response.

10. Acute
inflammation
Subperiosteal
abscess
Sequestrum
Involcrum
Cloacae

11. In infants
• More common epiphysial
and adjacent joint spread
• Deformed joint, bizzare
new bone formation
In adults
• Medullary spread in long
bone

12. Clinical features
In child:
• Recent history of
infection
• Severe pain, malaise,
fever
• Acute tenderness near
one of the larger joints
• ‘Pseudoparalysis’.

13. Infants
• History of birth difficulties,
umbilical artery
catheterization or a site of
infection
• Fails to thrive
• Drowsy but irritable.
• Metaphyseal tenderness
and resistance to joint
movement
Adults
• History of some urological
procedure followed by a
mild fever and backache.
• Local tenderness
• Easily missed diagnosis
in elderly, and in those
with immune deficiency,

14. Diagnostic imaging
•Plain x-ray
•Ultrasonography
•Radionuclide
scanning
•Magnetic resonance
imaging

18. • Bone scan reveals increased tracer uptake in the right
tibia

19. • Sagittal T2 reveals
marrow edema in the
distal tibia which crosses
the physis to invade the
epiphysis

20. Investigations
• Aspiration analysis
• Blood culture
• CRP within 12–24 hours
• ESR within 24–48 hours

21. Differential diagnosis
Cellulitis
• Widespread
superficial redness
and lymphangitis.
• MRI
• Oral or intravenous
antibiotics

22. Acute suppurative arthritis
• Diffuse tenderness
• Joint movement abolished
Streptococcal necrotising myositis
• Intense pain ,board-like swelling
• MRI :muscle swelling, signs of tissue
breakdown.
•Intravenous antibiotics surgical
debridement , amputation

23. Acute rheumatism
•Less severe migratory pain
•signs of carditis, rheumatic nodules or
erythema marginatum
Sickle-cell crisis
• Salmonella
Gaucher’s disease
•“Pseudo-osteitis’
•enlargement of the spleen and liver.

24. Management
• Supportive treatment for pain and
dehydration.
• Splintage (Simple skin traction , plaster
slab )
• Appropriate antimicrobial therapy.
• Surgical drainage.

26. Age Group Types of antibiotics
Neonates up to 6months
• Flucloxacillin + 3rd gen cephalosporin
• Flucloxacillin + benzylpenicillin + gentamycin
Children 6months-
6years
• IV flucloxacillin + cefotaxime / cefuroxime
Older child & previously
fit adults
• IV flucloxacillin + fusidic acid
• For known strep infection : benzylpenicillin
• Allergic to penicillin : 2nd- or 3rd- gen of
cephalosporin like cefotaxime
Elderly & previously
unfit patient
• Combination of flucloxacillin + 2nd-/3rd- gen
cephalosporin

27. Condition Types of Antibiotics
Sickle-cell disease patient
• Chloramphenicol,
• Third-generation cephalosporin
/fluoroquinolone
Heroin Addicts &
immunocompromized patient
• Third-generation cephalosporins
• Flouroquinolone (ciprofloxacin)
Patient to be risk at MRSA with
acute hematogenous OM
• IV vancomycin + 3rd- gen of
cephalosporin

28. Drainage
• When ?
• Clinical features do not improve within 36 hours
• Signs of deep pus
• Pus is aspirated
• Drained by open operation under general anaesthesia.
• (no obvious abscess) drill into medullary cavity
• (extensive intramedullary abscess) cut a small window in the
cortex.
• Close wound without drain,
• Reapplied traction ,
• Encourage movements (crutches)

29. Complications
• Epiphyseal damage and altered bone
growth
• Suppurative arthritis
• Metastatic infection
• Pathological fracture
• Chronic osteomyelitis

30. Referance
• Louis Solomon, David Warwick,
Selvadurai, Apley's System of
Orthopaedics and Fractures 9th edition
• Maheshwari & Mhaskar ,Essential
Orthopedics, 5th edition
• http://www.nejm.org/doi/full/10.1056/NEJM
ra1213956