This document discusses osteomyelitis, an infection of bone tissue. It defines acute, subacute, and chronic osteomyelitis based on duration and describes their typical causes, symptoms, treatments, and complications. Acute osteomyelitis is usually pyogenic in nature and caused by bacteria like Staphylococcus aureus. It presents with pain, fever and can lead to bone necrosis if not treated promptly with antibiotics and drainage. Chronic osteomyelitis results when an infection fails to clear and can cause recurring symptoms, bone damage, and pathological fractures if not adequately addressed through surgery and long-term antibiotics.

1. OSTEOMYELITIS
DEDE

2. Osteomyelitis
 The term osteomyelitis does not
specify the causative organism or
the disease process

3. Osteomyelitis
Classification:
 Duration Acute, Subacute or Chronic
 Route of infection Hematogenous or Exogenous
 Host response Pyogenic or Granulomatous

4. Acute Pyogenic Osteomyelitis
Definition:
 AO is an infection of bone
involving the periosteum,
cortical bone and the
medullary cavity.

5. Acute Pyogenic Osteomyelitis
Incidence:
 Age more in children
 Sex boys > girls
 Bone affected all bones
 Site of infection metaphysis

6. Acute Pyogenic Osteomyelitis
Organism:
 Neonates:
Staph aureus, Strept, E coli
 Children:
Staph aureus, E coli, Serriata, Pseudomonas, H inf
 Sickle-cell anemia:
Staph aureus, Salmonella

7. Acute Pyogenic Osteomyelitis
Source of Infection:
 Hematogenous
 Direct spread
 Exogenous

9. Acute Pyogenic Osteomyelitis
Pathology:
 Primary focus and stage of inflammation
 Spread of infection with pus formation
 Formation of subperiosteal abscess
 Pus tracks toward skin to form a sinus
 Bone infarction (Sequestrum)
 New bone formation (involucrum)

12. Acute Pyogenic Osteomyelitis
Age variation
Neonates:
 Extensive bone necrosis
 Increased ability to absorb large sequestrum
 Increased ability to remodel
 Epiphysio-metaphyseal vascular connection
leading to secondary septic arthritis

13. Acute Pyogenic Osteomyelitis
Age variation
Adults:
 No subperiosteal abscess due to adherent
periosteum
 Soft tissue abscess
 Vascular connection with the joint leading to
secondary septic arthritis

14. Acute Pyogenic Osteomyelitis
Clinical Pictures
History:
Skin lesion
Sore throat
Trauma

15. Acute Pyogenic Osteomyelitis
Clinical Pictures
Symptoms:
 Pain, restless
 Malaise and fever
 The limb is held still
(pseudo paralysis)
 Sometimes mild or
absent (neonates)

16. Acute Pyogenic Osteomyelitis
Clinical Pictures
Signs:
General and Local
Laboratory Tests:
– CBC
– ESR+CRP
– Blood culture (+ve in 50-70%)
– Aspiration (Gram stain + culture and sensitivity)

17. Acute Pyogenic Osteomyelitis
Radiography
 Plain X-ray
 Ultrasound
 Bone & gallium scan (Sensitive but not specific)
 CT scan
 MRI

22. Acute Pyogenic Osteomyelitis
Differential Diagnosis
 Acute Septic Arthritis
 Acute monoarticular
rheumatoid arthritis
 Sickle cell crisis
 Cellulitis
 Ewing’s Sarcoma

23. Acute Pyogenic Osteomyelitis
Treatment
General:
 Hospitalization
 Hydration
 Electrolyte replacement
 Analgesia
 Immobilization

24. Acute Pyogenic Osteomyelitis
Treatment
Antibiotics:
Type?
Route?
When to start?
When to stop
Monitoring?

25. Acute Pyogenic Osteomyelitis
Treatment
Surgical Drainage:
Indications?
Procedure?
Drilling?

26. Acute Pyogenic Osteomyelitis
Prognosis
Factors affecting prognosis:
 Organisms
 Infected Bone
 Age of the Patient
 Treatment

27. Acute Pyogenic Osteomyelitis
Complications
 Septicemia & metastatic abscesses
 Septic arthritis
 Growth disturbance (children)
 Pathological fracture
 Chronic osteomyelitis

33. Subacute Osteomyelitis
 Longer history and less virulent organism
 Insidious onset, Mild symptoms
 Pain is the most consistent symptom
 Usually no constitutional symptoms

34. Subacute Osteomyelitis
 Abnormal initial radiographs
 Inconclusive laboratory data
 Negative cultures/ biopsy
 Difficult to distinguish from bone tumors
e.g. Ewing’s, osteosarcoma

40. Chronic Osteomyelitis
Factors responsible for chronicity
 Local factors: Cavity, Sequestrum, Sinus,
Foreign body, Degree of bone necrosis
 General: Nutritional status of the involved
tissues, vascular disease, DM, low immunity
 Organism: Virulence
 Treatment: Appropriateness and compliance
 Risk factors: Penetrating trauma, prosthesis,
Animal bite

41. Chronic Osteomyelitis
Types
 A complication of acute Osteomyelitis
 Post traumatic
 Post operative

46. Chronic Osteomyelitis
Clinical picture
 Continuous or intermittent suppuration and sinus
formation with acute exacerbations.
 Pain, fever, redness, and tenderness during
acute exacerbations.
 Discharging sinus with +ve/-ve culture.
 Pathological fracture.

48. Chronic Osteomyelitis
Investigation
 Lab tests/ culture
 Plain X-ray:
Bone rarefaction surrounded by the dense
sclerosis, sequestration and cavity formation
 Sinogram
 Bone scan & gallium scan
To detect chronic multifocal osteomyelitis
 CT Scan & MRI
 Biopsy

54. Chronic Osteomyelitis
Treatment
 Antibiotics
 Surgical treatment
Preoperative assessment & preparation
Derbridement
Sequestrectomy
Local antibiotics
Stability
Treatment of bone cavity

57. Chronic Osteomyelitis
Complications
 Recurrence & Recurrence & Recurrence
 Pathological fractures
 Growth disturbance
 Amyloid disease
 Epidermoid carcinoma of the fistula