Osteomyelitis is inflammation of bone and bone marrow that is usually caused by bacterial infection. Acute hematogenous osteomyelitis is the most common type seen in India, typically affecting the distal femur or proximal tibia in children. Staphylococcus aureus is the main causative organism. It presents with fever, pain, and swelling over the affected bone. Diagnosis is made through clinical features, lab tests showing elevated inflammatory markers, and imaging showing bone changes. Treatment involves antibiotics, surgical drainage of abscesses, and rest.

2. Introduction
 Osteomyelitis is defined as inflammation of bone &
bone marrow.
 Caused by infective organisms like
a. non specific pyogenic organisms : staph & strepto.
b. specific organisms : TB Osteomyelitis, Syphilitic
osteomyelitis, Typhoid osteomyelitis.
c. Myecetomal infections : Actinomycosis or
Madhuramycosis
d. Parasitic infections : Echinococcus.

3. PYOGENIC OSTEOMYELITIS
ROUTES OF INFECTION:
• Haematogenous spread
• Direct invasion : from atmospheric air in open
fractures.
• Spread from neighbouring focus
e.g. - mastoiditis from middle ear infections
- osteomyelitis of mandible from dental root abscess

4. CLINICAL TYPES OF PYOGENIC
OSTEOMYELITIS
1. Acute osteomyelitis.
2. Chronic osteomyelitis.
3. Primary sub acute osteomyelitis.
4. Acute flare up of chronic osteomyelitis.

5. ACUTE PYOGENIC OSTEOMYELITIS
• Mc in India - Acute hematogenous osteomyelitis.
• Mc site – distal end of femur & proximal end of the tibia.
• Mc causative organism – Staphylococcus aureus.
PREDESPOSING FACOTORS:
Age – childhood & adolescence.
Septic focus- impetigo, septic tooth or tonsil.
Trauma – to bone localise the infection & initiates the infective
process.

6. PATHOLOGY:
 Initial focus in the metaphyseal region of the bone.
 Due to slowing of circulation in capillary loops of
metaphysis.
 Infection starts in the medullary tissue resulting in focus of
suppuration & spreads outwards to the surface & forms
subperiosteal abscess.
 Bursting of this abscess results in sinus.
 Infection can spread subperiosteally towards middle of the
shaft raising the periosteum of the bone & also along the
medullary canal to the middle of diaphysis.

7. Contd.
• In the upper end of tibia & lower end of femur the
epiphyseal plate is extra articular & the firm attachment
of periosteum near the epiphyseal plate prevents spread
of infection to the joint.
• But in intra- articular joints the joint capsule is attached
distally e.g. upper end of femur & the upper end of
humerus.
• The focus of osteomyelitis in the intra-articular part of
metaphysis, on extension to the surface of bone involves
the joint & causes Septic arthritis of that joint.

8. CLINICAL FEATURES:
 Fever, acute pain & swelling above or below the knee joint.
 Mc in children.
O/E:
• Diffuse swelling, warmth & acute tenderness over the area
of bone involved.
• Child unable to move the limb – pseudo paralysis.
On palpation:
• Fluctuant abscess – knee joint may be swollen with a
“Sympathetic effusion with sterile fluid”.

9. RADIOLOGICAL FEATURES:
 Early stages – no radiological changes.
 > 2 weeks – patchy areas of destruction & slight periosteal
reaction
 Technetium 99 scan – increased uptake in early cases.

10. LABORATORY FINDINGS:
 WBC count – increase in total count with high
polymorphs.
 ESR – raised
 Blood culture – reveals the causative organism.

11. TREATMENT:
 Affected part is rested in a splint.
 Combination of i.v antibiotics with broad spectrum of
bactericidal activity are given.
 Virulent infection may proceed to uncontrolled abscess.
 Abscess – surgical drainage under general anaesthesia.
 Soft tissue abscess – drained by an incision.
 Sub periosteal collection of pus – incised & drainage.
 Few drill holes are made to drain pus in the medullary
cavity.
 Pus sent for smear, culture & sensitivity to antibiotics.
 Appropriate antibiotics for atleast 4-6 weeks should be
continued.

12. DIFFERENTIAL DIAGNOSIS :
 Anterior poliomyelitis – due to inability to move the limb
& fever.
 Septic arthritis of the joint – mimics acute stage
 Acute rheumatic fever- due to joint line tenderness.