2. DEFINITION:-
Osteomyelitis is an infection of the bone.
INCIDENCE:-
Only 2 out of every 10,000 people get osteomyelitis.
The condition affects children and adults, although in
different ways.
3. TYPES:-
There are 2 types. They are:-
Acute osteomyelitis
Chronic osteomyelitis
ACUTE OSTEOMYELITIS:
Acute osteomyelitis develops rapidly over a period of
seven to 10 days
CHRONIC OSTEOMYELITIS:
People with diabetes, HIV, or peripheral vascular disease
are more prone to chronic osteomyelitis which persists or
recurs, despite treatment. Osteomyelitis often affects an
adult's pelvis or vertebrae of the spine. It can also occur in
the feet, especially in a person with diabetes.
4. ETIOLOGY:-
In most cases, a bacteria called Staphylococcus aureus
causes osteomyelitis. It is a type of germ commonly
found on the skin or in the nose of even healthy
individuals.
Other organisms are:
Proteus
Pseudomonas
Escherichia coli
5. WAYS OF TRANSMISSION OF INFECTION:-
Germs can enter a bone in a variety of ways, including:
Via the bloodstream.
From a nearby infection.
Direct bone contamination.
VIA THE BLOODSTREAM:
Germs in other parts of the body — for example from
pneumonia or a urinary tract infection — can travel through
bloodstream to a weakened spot in a bone.
FROM A NEARBY INFECTION:
Severe puncture wounds can carry germs deep inside the body.
If such an injury becomes infected, the germs can spread into a
nearby bone.
DIRECT BONE CONTAMINATION:
Direct contamination can occur during surgeries to replace
joints or repair fractures.
6. RISK FACTORS:-
Recent injury or orthopedic surgery
Bone fracture
Deep puncture wound.
Deep animal bites
Bone surgery, including hip and knee replacements
Circulation disorders
Poorly controlled diabetes
Peripheral arterial disease, often related to smoking
Sickle cell disease
Poor blood supply
7. Problems requiring intravenous lines or catheters
Dialysis machines
Urinary catheters
Long-term intravenous tubing, sometimes called
central lines
Conditions that impair the immune system
Chemotherapy
Poorly controlled diabetes
Having had an organ transplant
Needing to take corticosteroids or drugs called tumor
necrosis factor (TNF) inhibitors.
HIV or AIDS
8. Illicit drugs
People who inject illicit drugs are more likely to
develop osteomyelitis because they typically use
nonsterile needles and don't sterilize their skin before
injections.
Others:
Poorly nourished
Elderly
Obese
Rheumatoid arthritis
Alcoholism
9. PATHOPHYSIOLOGY:-
Bone infection
Inflammation, increased vascularity & edema
Thrombosis of the blood vessels
Ischemia with bone necrosis
Infection extends into the medullary cavity & under
the periosteum and may spread into adjacent soft
tissues & joints
Bone abscess
10. SIGNS AND SYMPTOMS :-
Fever or chills
Pain in the area of the infection
Fatigue
Nausea
Tenderness, redness, and warmth in the area of the
infection
Inflammation, swelling & drainage
Loss of range of motion
If the vertebrae is affected then severe back pain,
especially at night.occurs.
Sometimes osteomyelitis causes no signs and symptoms
or has signs and symptoms that are difficult to distinguish
from other problems.
11. DIAGNOSTIC EVALUATIONS:-
Blood tests
Blood tests may reveal elevated levels of white blood cells
and other factors
Wound culture
Imaging tests
X rays.
Computerized tomography (CT) scan.
Magnetic resonance imaging (MRI).
Bone biopsy
A bone biopsy is the gold standard for diagnosing
osteomyelitis, because it can also reveal what particular
type of germ has infected the bone
12. MANAGEMENT:-
MEDICAL MGT:
Hydration
Diet high in vitamins & protein
Correction of anemia
Immobilization of the affected area
Application of warm wet soaks for 20 mts several
times a day.
13. PHARMACOLOGIC THERAPY:
IV antibiotic therapy is given for upto 3-6 weeks.
After the control of infection the drug is given orally
for upto 3 months.
SURGICAL MGT:
Surgical debridement
Sequestrectomy – removal of enough involucrum to
enable the surgeon to remove the sequestrum.
Saucerization – removal of sufficient bone and then
the cavity is packed with bone graft and muscle flap.
14. COMPLICATIONS:-
Bone death (osteonecrosis).
Septic arthritis.
Skin cancer.
PREVENTION:-
To avoid cuts and scrapes, which give germs easy
access to the body. If any cuts and scrapes occurs
clean the area immediately and apply a clean bandage.
Check wounds frequently for signs of infection.