Acute and chronic osteomyelitis

Pembimbing
Dr.Jafri Hasan, SpOT
Nur Hamizah Hashim
11.2012.248

Definition
Acute osteomyelitis
Infections of the bone

Acute Hematogenous osteomyelitis

A rapidly developing blood borne bacterial infection of
bone and its marrow

Chronic osteomyelitis
bone infection predicated on preexisting osteonecrosis

Epidemiology of acute
osteomyelitis
Most frequently in
the long bones

=3:1

Etiology of acute osteomyelitis

Portal of entry
Scratches, abrasions
etc
Mucous membrane of
respiratory tract
Local trauma

staphylococcus aureus
streptococcus and
pneumococcus

10%
90%

Patogenesis of acute osteomyelitis

Symptoms

High fever and chills (may be

absent in infants)
Swelling, redness and warmth
over the infected area
Restricted range of movement in
the affected area
If osteomyelitis develops
following an injury then the
symptoms may include pus
coming out from a wound
Irritability in young children
General discomfort, malaise,
uneasiness

Diagnosis
Leucocytes count increase
X-ray will be seen normal
in the 1st week
USG
Scintigraphy: 3 phase bone
scan
Nuclear
angiogram(injection of
pharmaceutical)
Blood pool image
Bone image(3 hours later)

MRI

Treatment

Supportive measures; eg intravenous fluid

Removable splint to prevent fractures
Broad spectrum antibiotics
Surgical decompression (after 24 hours of
intensive treatment without improvement)
Drilling of bone
Evacuation of the subperiosteal pus

Prognosis
Depends on:
Time interval between the onset of infection and the
treatment
The effectiveness of the antibiotics and the causative
bacteria
The dosage of the antibacterial drugs

Complications
Early
Death from septicemia
Abcess formation
Septic arthritis

Late

Chronic osteomyelitis
Pathological fracture
Joint contracture
Local growth disturbance

Chronic Hematogenous
Osteomyelitis

Chronic hematogenous
osteomyelitis
Inadequate treatment of acute phase
Failure to diagnose acute osteomyelitis
Failure to provide effective antibacterial therapy
Failure to intervene surgically when indicated in the acute
phase

Pathogenesis

Formation of a sequestrum: (A),

sound bone; (B), new bone; (C),
granulations lining involucrum;
(D), cloaca; (E), sequestrum

Clinical features

Swelling
Tenderness
Loss of function
Maybe one or more draining sinuses

Diagnosis
Radiography
Presence of
sequestra
Brodies abcess

Treatment
Extruded
spontaneously through
a cloaca
Sequestrectomy
Saucerization
the excavation of tissue to
form a shallow shelving
depression, usually
performed to facilitate
drainage from infected
areas of bone.

Complications
1.
2.
3.
4.

Joint contracture
Pathological fracture
Amyloid disease
Malignancy of the epidermis(epidermoid
carcinoma)