Introduction to Osteomyelitis - Introduction to Orthopedics - Lecture Slides, Slides for Orthopedics. All India Institute of Medical Sciences
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Introduction to Osteomyelitis - Introduction to Orthopedics - Lecture Slides, Slides for Orthopedics. All India Institute of Medical Sciences

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Introduction to Osteomyelitis, Bone Infections, Subacute Osteomyelitis, Bone Marrow, Bloodstream, Acute Osteomyelitis, Hematogenous Osteomyelitis, Direct Inoculation Osteomyelitis are some points from this lecture of Ort...
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Osteomyelitis

Osteomyelitis Bone Infections

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Outline

• Acute Osteomyelitis

• Subacute Osteomyelitis

• Post-Operative Infections

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DEFINING OSTEOMYELITIS

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DefiningOsteomyelitis

What’s in a Name?

Osteomyelitis (Osteo- bone, Myelo- Marrow, and –itis -Inflammation)

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DefiningOsteomyelitis

What is it?

It is an infection of the of the bone or bone marrow which leads to a subsequent

Inflammatory process.

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DefiningOsteomyelitis

Where does it come from?

Micro-Organisms may reach bones via the Bloodstream or by Direct Invasion.

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DefiningOsteomyelitis

What affects it’s development?

Organism involved

Host Factors (i.e. Age, Immunity, Diseases)

Site of Involvement (i.e. local factors)

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DefiningOsteomyelitis

What affects it’s development?

Organism involved

Host Factors (i.e. Age, Immunity, Diseases)

Site of Involvement (i.e. local factors)

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ACUTE OSTEOMYELITIS

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Acute Osteomyelitis

Types of Acute Osteomyelitis I. Hematogenous Osteomyelitis

II. Direct Inoculation Osteomyelitis

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Acute Osteomyelitis

Hematogenous Osteomyelitis: Bacterial seeding from the blood.

Seen primarily in Children.

The most common site is the Metaphysis at the

growing end of Long Bones in Children, and The Vertebrae and pelvic in Adults.

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Acute Osteomyelitis

Direct Inoculation Osteomyelitis Direct contact of the tissue and bacteria as a

result of an Open Fracture or Trauma. Tend to involve multiple organisms.

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Acute Osteomyelitis

Causative Organisms:Staphylococcus aureus (Mainly)

Streptoccous pyogens or pneumoniae. (Less)

H.Influenzae (Young Children)

Salmonella (Sickle-Cell)

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Acute Osteomyelitis

Pathology:Inflammation. Earliest Change Increase interaosseous pressure leads to Pain.  Suppuration. • Pus @ Medulla =Volkmann canals=>Surface =>

Subperiosteal Abscess=> spread along the shaft=> re- enter the bone or burst into the soft tissue

• May extend to Epiphysis and Metaphysis in Neonates and Children. May extend to Interverteberal Discs in Adults.

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Acute Osteomyelitis

Pathology:Necrosis. Begin to see signs with in one week.

 New-bone formation. • Bone thickens to form an involucrum enclosing the

infected tissue. • Perforation may occur converted acute into chronic

osteomyelitis.  Resolution.

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Acute Osteomyelitis

Clinical Features:Pain Fever and Malaise Tenderness Restricted Joint Movement Redness, Edema, Warmth (Signify Pus) History preceding Skin Lesion or Sore Throat.

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Acute Osteomyelitis

Imaging:First 10 days X-Rays Show No Abnormality. By the end of the 2nd Week signs of rarefaction

of Metaphysis and New Bone Formation. With Healing there is Sclerosis and thickening of

Cortex. MRI may help to distinguish between Bone and

Soft-Tissue Infection.

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Acute Osteomyelitis

Investigations:CBC

 Leucocytosis  C-reactive protein level usually is elevated

 ESR usually is elevated

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Investigations

1. Lab studies

2. Radiological studies

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Lab studies CBC: leucocytosis

The C-reactive protein level usually is elevated

(nonspecific but more useful than ESR). ESR usually is elevated (90%) nonspecific.

Aspiration of the pus from the subperiosteal abscess and culture, and test sensitivity for antibiotics

Blood culture results are positive in only 50% of patients with hematogenous osteomyelitis.

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Radiological studies X-Ray:  First sign is soft-tissue edema at 3-5 days after

infection.  Bony changes are not evident for 14-21 days: 1. early radiographic signs of rarefraction (thining of bony tissue

sufficient to cause decreased density of bone) of the metaphysis and periosteal new bone formation

2. increasing ragged if treatment is delayed 3. sclerosis and thickening of the bone at healing

 Approximately 40-50% focal bone loss is necessary to cause detectable lucency on plain films.

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• Plain-film radiograph showing osteomyelitis of the second metacarpal (arrow). Periosteal elevation, cortical disruption and medullary involvement are present.

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Radiological studies • MRI :

Early detection and surgical localization of osteomyelitis.

Sensitivity ranges from 90-100%.

• Radionuclide bone scanning : A 3-phase bone scan with technetium 99m is

probably the initial imaging modality of choice Show increase activity but it is a non specific sign of

inflamation.

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Radiological studies CT scan (spinal vertebral lesions, complex

anatomy: pelvis, sternum, and calcaneus) Ultrasound

In children with acute osteomyelitis. May demonstrate changes as early as 1-2 days after

onset of symptoms. Abnormalities include soft tissue abscess or fluid

collection and periosteal elevation. Ultrasonography allows for ultrasound-guided

aspiration. It does not allow for evaluation of bone cortex

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Diagnosis Diagnosis requires 2 of the 4 following criteria: ◦ Localized classic physical findings of bony

tenderness, with overlying soft-tissue erythema or edema.

◦ Purulent material on aspiration of affected bone. ◦ Positive findings of bone tissue or blood culture. ◦ Positive radiological imaging study.

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