infection of bone

1. OSTEOMYELITIS
RITIKA KISHORE 56

2. DEFINED as the infection of
the bone by the micro-
organisms .

3. Diff types are :-
• Acute
• Secondary
• Chronic
• Garre’s
• Brodie’s
• Salmonella
• Septic arthritis
• Gonococcal arthritis
• Syphilis of the joints
• Fungal
• Leprosy
• Subacute

6. Extra-articular :
the capsule is attached at the
junction of the epiphysis with the
metaphysis.
Intra-articular :
the infection of the metaphysis can
spread to the joint, resulting in
pyogenic arthritis.

7. ACUTE OSTEOMYLITIS
• Primary or haematogenous, seen commonly
in children
• Secondary, arises from wound infections in
open fractures or after surgeries on the
bone.

10. PATHOGENESIS
• Reach bone via circulation.
• Lodge into metaphysis.
• Inflammatory reaction leads to bone
destruction and production of inflammatory
exudates and cells.
SITES
commonly-
-Lower femoral (commonest)
-Upper tibial
-Upper femoral
-Upper humeral metaphysis.

15. DIAGNOSIS
• Mostly clinical
• In childhood
• Boys > girls

16. CLINICALLY
• Seen in children
• Boys > girls
• Pain acute in onset
• Swelling
• Fever
• May even affect - a). Tonsils
b). Skin

19. Examination
• Febrile
• Dehydrated
• Signs of inflammation - a). Redness
b). Heat
• Abscess in muscle or subcutaneous plate
• Sympathetic effusion
• Concomitant arthritis.

20. INVESTIGATIONS
• Blood – polymorphonuclear leucocytosis
• Raised ESR
• Blood culture
• X-ray :
periosteal new bone deposition at
metaphysis.
• Bone scan :
using Tecnetium-99 shows increased uptake.
Indium-11 is most specific.

23. DIFFERENTIAL DIAGNOSIS
• Acute septic arthritis
- localised swelling and tenderness.
- painful and restricted movement.
- examine fluid for inflammatory cells.
• Acute rheumatic arthritis
• Scurvy
• Acute poliomyelitis

24. TREATMENT
• As early as possible.
• Depends on duration of illness.
• If within 48hrs :
- rest
- antibiotics
- general building-up
- splint or traction
<4m : ceftriaxone + vancomycin
Older : ceftriaxone + cloxacillin
• Rehydrate the child
• Record temp. and pulse after every 4hrs.
• Restrict weight bearing for 6-8weeks.

26. COMPLICATIONS
• General
• local
General –
a). Septicaemia
b). Pyaemia.

27. Local –
due to :
i). Delay in diagnosis
ii). Inadequate treatment
a). Chronic osteomyelitis
- commonest
- no radiological findings
- sequestrum formation
- pus
- poor host resistance.
b). Acute pyogenic arthritis
- joints ( mainly hip and shoulder ) .

28. c). Pathological fracture
- weakened bone by disease
- window made during surgery
can be avoided by adequately splinting the
limb.
d). Growth plate disturbances
- may be damaged
- complete or partial cessation of growth.
- shortening of limb
- lengthening of limb
- deformity of limb.