Chronic osteomyelitis

When the duration of osteomyelitis is more than 3 weeks, its called ch. Osteomyelitis.

Causes-1.Trauma causing open fractures.2.Post operative.3.Osteomyelitis with chronic etiology-- TB- Brodie’s abscess.- Fungal osteomyelitis.

Pathology.

1. Necrosis. stage of new bone formation involucrum. with sequestrum inside, there will always be a persistent discharging sinus. pus from bone escapes through multiple hole in involucrum

Clinical features-

- Pain, swelling.- Discharging sinus. - Bone thickening.- Deformity.- Joint stiffness.- Shortening of limb, - Pathological fracture.- Sinus track malignancy.

• .

•Discharging sinus

Investigation.• CBC, ESR.• Pus for c/s.• X – ray – sequestrum deformity. - periosteal thickening,

sclerotic lesion. - irregular soft tissue shadow. - regional osteoporosis. - pathological fracture , micro

fracture.• CT.• MRI

D/D-1.TB osteomyelitis- watery discharge. - previous h/o TB, sinus with undermined

margin with blue colour.2. Ewing's sarcoma- A primary malignant tumor of

bone, usually arising as a central tumor in long bone. (biopsy)

3. Soft tissue chronic infection. (X-ray)

Treatment.

Supportive treatment .• Antibiotics – to prevent spread.• Surgery – sequestretomy + saucerization

(excavation of the tissue of a wound to form a shallo )

Complication.

• Joint stiffness.• Shortening.• Muscle contracture.• Pathological fracture.• Sinus track malignancy.• Amyloidosis.

Brodie’s abscess - it is an intraosseous abscess walled by

reactive boneCause- staph.aureus.Common site- metaphysis of long bone,

cancellous bone.

Clinical features- pain, fever, swelling, thickening of bone,

X- ray radiolucent area in sub

periosteum surrounded by sclerotic bone.

Treatment-Fenestration + antibiotics (two

days of intravenous antibiotics and then oral antibiotics for six weeks )

Septic arthritis

• Collection of pus inside the joint.• Common in knee and hip.• Cause- staph. Aureus, strept. pyogens, E. coli,

pseudomonas, haemophilous influenza,

Mode of infection-1.Haematogenous.2.Direct penetrating wound to joint,3.Joint aspirations, steroid injection, contrast

injection, arthroscopy.4.Spreading infection from near by bone.

Mode of infection

Microbes synovial membrane inflammation (synovitis). increased synovium formation seorus/ seropurulent discharge erosion of cartilage - spreading of pus to the bone and destruction of bone.

- escaping of pus outside the joint through sinus.

Clinical features

• Neonates- increased pulse rate, fever, irritable, ignore feeding, swelling of joint, resist the movement of affected joint, pain.

• Children- swelling, increased pulse rate, fever, restriction of movement of joint.

• Adult- usually in immunocompromised or with other existing diseases.

Investigation.

• CBC, ESR.• Pus for c/s , gram staining.• Blood for c/s• X-ray – initially normal. - initially increased joint space. - later joint space decreases. - osteopenia.• USG- collection of pus inside the joint space.

D/D

• Acute osteomyelitis.• Haemarthaesis.- post traumatic. - aspiration.• Acute rheumatism.• Haemophilic joint• Gout.

Treatment

• Supportive measures- 2 wks of IV antibiotics followed by 4-6 wks of oral antibiotics.

• Symptomatic.(pain, fever)• Splintage of affected limb.• Surgery – arthotomy and evacuation of pus.

Complications.

• Dislocaton of joint.• Deformity around joint.• Bony ankylosis.