Pathogenesis of Post traumatic osteomyelitis.

In adults osteomyelitis is most often related to open fractures or to any surgical procedure
affecting bone or its adjacent tissues. Traumatic contaminated wounds may also progress to deep
infection and osteomyelitis. Especially diabetic patients with poor circulation are prone to that
mechanism.
Osteomyelitis associated with fractures can cause delayed union or non-union and complicate the
treatment.
The most common predisposing factor for osteomyelitis is an area of bone or contiguous
surrounding tissue that is abnormal in terms of viability, blood supply, sensation, or edema.
The damaged tissue not only compromises healthy circulation to the area but may slow
the flow of venous blood and lymph, thereby providing nutrients to bacteria and fueling
ongoing damage.
(! The e"tent of soft tissue damage and impairment of blood supply#
($! Inoculation of bacterial flora#
(%! The instability of the fracture area#
(&! The general defensive condition of the organism. The symptoms of acute
osteomyelitis are those of acute inflammation.
E"planation'
-(amaged bone and soft tissue e"pose numerous proteins, such as collagen and fibronectin,
which bacteria can adhere to.
- In acute osteomyelitis inflammation is followed by local edema, bone infarction and resorption.
-Infection can trac) along *aversian and +ol)mann canals out of the intramedullary canal to the
corte", causing disruption of cortical blood supply.
-,ome of the dead cortical bone is detached gradually from the living bone to form a se-uestrum.
.fter cortical and periosteal disruption.
(,ummarised!
-Obstruction of small vessels due to coagulopathy and oedema/ cortical bone undergoes
necrosis/ detached from surrounding live bone/ creating an area )nown as a se-uestrum/
further bacterial invasion and progression continues. / induction of bone begins at the intact
periosteum, forming a layer of viable osseous tissue around the site of infection )nown as
involucrum.
-0ultiple organisms are usually isolated from infected bone as a result of an open fracture.
,taphylococus aureus remains the most commonly isolated pathogen. 1ram-negative bacilli and
anaerobic organisms are also fre-uently isolated
2 Staph.aureus
-The bacteria involved in osteomyelitis perpetuate themselves by elaborating to"ins that further
damage tissues..
-,ome S. aureus bacteria survive upta)e into the phagocytic vacuoles of macrophages and
continue to cause disease and recrudescence by persistently eluding the usual defense
mechanisms.
- This 3*ibernation4 allow S. aureus to remain dormant for decades before infection erupts at the
sites of old injuries.
-5oagulase-negative staphylococci' not virulent as staph.aureus,they can persist by producing a
biofilm that protects them from the host and apparently allows them to e"ist for many years on
prosthetic joints, with minimal symptoms.
Pathologic features of chronic osteomyelitis
- The presence of necrotic bone, the formation of new bone, and the e"udation of
polymorphonuclear leu)ocytes
joined by large numbers of lymphocytes, histiocytes, and occasionally plasma cells.
- 6ew bone forms from the surviving fragments of periosteum and endosteum
in the region of the infection.
- It forms an encasing sheath of live bone, )nown as an involucrum, surrounding the dead bone
under the periosteum.
-The involucrum is irregular and is often perforated by openings through which pus may trac)
into the surrounding soft tissues and eventually drain to the s)in surfaces, forming a chronic
sinus
Host Factor
Inflammatory response to infection
Genetics
Osteomyelitis secondary to host disease
Implanted materials and osteomyelitis
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