2. DEFINATION
• Osteomyelitis is an inflammatory process accompanied by bone
destruction and caused by an infecting microorganisms.
• Osteomyelitis can be acute or chronic.
-Reference: osteomyelitis dp lew, fa waldvogel - the lancet, 2004 - elsevier
3. TYPES OF OSTEOMYELITIS
1. DURATION- Acute, Subacute or chronic
2. ROUTE OF INFECTION- Haematogenous or Exogenous
3. HOST RESPONSE- Pyogenic (involving or relating to the production of pus) or
Granulomatous (Formation of Granuloma)
ACUTE OSTEOMYELITIS-
• It is an infection of bone involving the periosteum, cortical bone and the medullarycavity.
• Acute Haematogenous Osteomyelitis is mostly caused by STAPHYLOCOCCUS AUREUS.
REFERENCE- Essential orthopaedics (Maheshwari&mhaskar)6th edition.
6. PATHOGENESIS
• These organisms reach the bone via the blood circulation .
• The bacteria, as they pass through the bone gets lodged in the
metaphysis.
• The host bone initiates an inflammatory reaction in response to the
bacteria.
• These leads to bone destruction and production of an inflammatory
exudate and cell(pus)
• Once sufficient pus forms in the medullary cavity ,it spreads in the
following direction-
• Reference- Essential orthopaedics (Maheshwari&mhaskar)6th edition.
7. (a) ALONG MEDULLARY CAVITY-
-CAUSES THROMBOSIS OF VENOUS AND ARTERIAL MEDULLARY VESSELS.
-BLOOD SUPPLY TO A SEGMENT OF BONE IS THUS CUT OFF.
(b) OUT OF CORTEX- PUS TRAVELS ALONG VOLKMANN’S CANALS
COME TO LIE SUB PERIOSTEALLY
PERIOSTEUM IS THUS LIFTED OFF THE UNDERLYING BONE
RESULTING- DAMAGE TO THE PERIOSTEAL BLOOD SUPPLY TO
THAT PART OF THE BONE.
SEGMENT OF BONE IS THUS RENDERED AVASCULAR
Reference- Essential orthopaedics (Maheshwari&mhaskar)6th edition
8. Pus under periosteum- generates sub periosteal new bone
PERIOSTEUM PERFORATED
PUS OUT IN THE MUSCLE OR SUBCUTANEOUS PLANE
BURSTS OUT OF THE SKIN
Reference- Essential orthopaedics (Maheshwari&mhaskar)6th edition
9. Incidence:
• Age more in children
• Sex boys > girls
• Bone affected all bones
• Site of infection metaphysis
Organism:
• Neonates: Staph aureus, Strept, E coli
• Children: Staph aureus, E coli, Serriata, Pseudomonas, H inf
• Sickle-cell anemia: Staph aureus, Salmonella
Source of Infection:
• Hematogenous
• Direct spread
• Exogenous
10.
11. Clinical pictures-
• HISTORY:
Skin lesion
Sore throat
Trauma
• SYMPTOMS:
Pain,restless
Fever
The limb is held still(pseudo paralysis)
Sometimes mild or absent(neonates)
Reference- Essential orthopaedics (Maheshwari&mhaskar)6th edition
12. CHRONIC OSTEOMYELITIS:
• Acute (pyogenic) osteomyelitis when treated inadequately passes on to
chronic osteomyelitis .The other causes are weak host defense mechanism
due to malnutrition .
• The following are the characteristics features of chronic osteomyelitis:
1. Discharging sinus (fig1)
2. Irregular thickening of bone (fig 2)
3. Irregular surface of bone.
4. Deformity of limb
5. SHORTENING OF THE LIMB
6. JOINT STIFFNESS
14. INVESTIGATIONS-
• Lab test/culture
• X-ray: Bone surrounded by dense sclerosis , sequestration and cavity
formation .
• Sinogram: In this test, a sterile thin catheter is introduced into the sinus
as far as it can go. Then ,a radio-opaque dye is injected . This dye travels
to the root of the infection ,helps localise it better.
• Biopsy
• Reference-essentials of orthopaedics and applied physiotherapy(joshi& kotwal’s) 4th edition
15. COMPLICATION
• Recurrence
• Pathological fractures
• Deformity
• Limb length discrepancy- shortening occurs when the growth plate is
damaged due to infection .
• Stiffness – soft tissue contractures
Reference-essentials of orthopaedics and applied physiotherapy(joshi& kotwal’s) 4th edition
16. TUBERCULOUS OSTEOMYELITIS
• Routes of entry: usually blood borne and form a focus of active visceral disease.
Tuberculosis of the spine (pott disease)
Pott disease which is also known as caries (decay) spine is the tubercular infection of the vertebrae by m.
Tuberculosis.
Vertebra is the most common site of tuberculosis accounting for nearly 50% of the cases out of which, 60–
80% are seen in the lower dorsal and lumbar spine. This is due to the cancellous nature of bones and
body weight transmission through these areas.
The bacteria reach the spine via the haematogenous route from lungs or lymph nodes .
the lesion is common at the contiguous areas of the two adjacent vertebra . The spinal cord in the
affected region may get compressed due to collection of pus or sequestra or angular deformity of the
spine, leading to paraplegia/quadriplegia.
The anterior collapse of the vertebra may cause an angular (kyphotic) deformity resulting in prominent
spinous process which is known as a ‘gibbus’
Reference-essentials of orthopaedics and applied physiotherapy(joshi& kotwal’s) 4th edition
17. FIG-A. MRI of the same case showing destruction of vertebrae and a soft tissue mass encroaching
posteriorly into the spinal canal.
FIG-B Gibbus (arrow) in tuberculosis of spine
FIG A
FIG B
