prof. mamoun kremli. osteomyelitis osteo: bone, myelo: bone marrow, itis: inflammation an...
TRANSCRIPT
![Page 1: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/1.jpg)
Osteomyelitis
Prof. Mamoun Kremli
![Page 2: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/2.jpg)
Definition
Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation
An inflammation of the bone caused by an infecting organism (infection)
Mostly bacterial, can be fungal
![Page 3: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/3.jpg)
Types of Osteomyelitis
Acute Sub-acute Chronic
Non-specific: any organism Specific: example: Tb
Hematogenous: from blood stream Contiguous: from nearby tissue
![Page 4: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/4.jpg)
Acute Osteomyelitis
![Page 5: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/5.jpg)
5
Prevalence:
Children 1: 5000 Sickle cell patients 3.6: 1000 Post puncture wound to foot
Higher in developing countries
![Page 6: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/6.jpg)
Common patients
Almost invariably children, Adults:
Post open trauma Post surgery Debilitating disease Drug addicts: IV injection sites
www.firstaidreference.com/
www.winnipegsun.com/
![Page 7: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/7.jpg)
Etiology – source of infection
Micro-Organisms may reach bones via: Bloodstream, (commonest) from another infection
(e.g. tonsilitis, otitis media, umbilical,..),
http://dermatlas.med.jhmi.edu/http://en.wikipedia.org/wiki/Tonsillitis
![Page 8: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/8.jpg)
Etiology – source of infection
Micro-Organisms may reach bones via: Bloodstream, (commonest) from another infection
(e.g. tonsilitis, otitis media, umbilical,..), or Direct Invasion from neighboring tissues,
Fayad L M et al. Radiographics 2007;27
![Page 9: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/9.jpg)
Etiology – source of infection
Micro-Organisms may reach bones via Bloodstream, (commonest) from another infection
(e.g. tonsilitis, otitis media, umbilical,..), or Direct Invasion from neighboring tissues, or Direct to exposed bone in open fxs or operations
http://taycoleahcf.blogspot.com/ http://eorif.com/General/
![Page 10: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/10.jpg)
Etiology – causative Organisms
Staphylococcus Aureus (mainly) Streptococcus Pyogenes (less) Streptococcus Pneumoniae (less)
Children < 4 yrs: H influenzae
In Sickle cell disease: Salmonella
![Page 11: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/11.jpg)
Common sites
Children: Metaphysis of long bone: Femur, Tibia, Humerus
Older patients: Vertebral bone Any other bone
![Page 12: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/12.jpg)
Common sites
Why in metaphysis of long bone?: Sluggish blood flow through
loop-ended vessels and sinusoidal venous system
Poor collateral circulation Susceptibility of this region
to trauma - hematoma Deficiency of phagocytic
cells
![Page 13: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/13.jpg)
Pathology
Pathology varies – depends on: Age, Site of infection, Virulence of organism, Host response
![Page 14: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/14.jpg)
Pathology
Innoculation by organisms in bone marrow Inflammation:
Infiltration of neutrophils to bone Vessels are congested, with
hyperemia Exudates increase pressure
(painful)
Copyright © Mosby, Inc., an affiliate of Elsevier Inc.
![Page 15: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/15.jpg)
Pathology
Suppuration: (day 2-5) Increased pressure, leads to thrombosed vessels and
cause bone necrosis Periosteum elevated by the
subperiosteal abscess,reducing blood supply further,and causing bone necrosis
Could spread to joints in infantsand where metaphysis isintra-articular Copyright © Mosby, Inc., an affiliate of Elsevier Inc.
![Page 16: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/16.jpg)
Pathology
Necrosis: formation of Sequestrum (dead bone)
New bone formation (involucrum) encloses infected tissue
and could have openingsto outside, (cloacae)
Copyright © Mosby, Inc., an affiliate of Elsevier Inc.
![Page 17: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/17.jpg)
Pathology
Necrosis: results in dead bone (Sequestrum) New bone formation (involucrum) encloses
infected tissue and could have openings to outside (cloacae)
http://osteomyelitis.stanford.edu/http://www.uaz.edu.mx/histo/pathology/
Sequestrum Involucrum
![Page 18: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/18.jpg)
Histopathology
Dense inflammatory cell infiltrate in the marrow space
Adjacent bony trabeculae are necrotic note the absence of
osteocytes in lacunae
![Page 19: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/19.jpg)
Pathology
Resolution: Sclerosis, thickening of bone Deformity Chronic Osteomyelitis
![Page 20: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/20.jpg)
Pathology
http://blackpoppymag.wordpress.com/2011/03/21/osteomyelitis/
Microabscessin Metaphysis
Abscess spreadsPresure increases
Abscess spreadssubperiosteally
Necrotic boneresults from
cutoff blood supply
![Page 21: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/21.jpg)
Clinical features
Typical patient, with history of trauma Pain, malaise, fever, decreased mobility Recent history of infection Local tenderness Local redness, swelling (late sign),
differentiate from cellulitis
http://www.ptolemy.ca/ http://dermatlas.med.jhmi.edu/
![Page 22: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/22.jpg)
Radiology
First 10 days X-Rays Show No Abnormality.
By the end of the 2 weeks, signs of: Rarefaction of
Metaphysis, and
http://www.steadyhealth.com/
http://ortho.host56.com/
![Page 23: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/23.jpg)
Radiology
First 10 days X-Rays Show No Abnormality.
By the end of the 2 weeks, signs of: Rarefaction of
Metaphysis, and New Bone Formation
(periosteal reaction)
http://www.steadyhealth.com/
http://ortho.host56.com/
![Page 24: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/24.jpg)
Radiology
With Healing there is Sclerosis and thickening of Cortex.
http://connect.in.com/osteomyelitis
![Page 25: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/25.jpg)
Diagnosis
Clinical
![Page 26: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/26.jpg)
Diagnosis
Clinical X-ray:
soft tissue swelling, periosteal reaction (at 2 weeks) patchy rarefaction of metaphysis
US, MRI, Bone scan, CBC, ESR, CRP Aspiration of bone Blood C/S (positive only in 50%)
![Page 27: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/27.jpg)
Radiological studies
MRI : Early detection and
surgical localization of OM
helps to distinguish between bone and soft-tissue infection
Sensitivity ranges from 90-100%.
![Page 28: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/28.jpg)
Radiological studies
Radionuclide bone scanning : Technetium 99m bone scan is probably the initial
imaging modality of choice Show increase activity
but it is non-specific
http://ortho.host56.com/
![Page 29: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/29.jpg)
Radiological studies
Radionuclide bone scanning : More sensitive than X-rays (early detection)
![Page 30: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/30.jpg)
Investigation
CBC: increased WBC ESR: raised CRP: high (more specific and more sensitive)
Bone aspiration: Diagnostic,
▪ Identifies bacteria by culture▪ Check sensitivity for antibiotic choice
http://reference.medscape.com/
![Page 31: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/31.jpg)
Treatment
Aim of treatment Should detect and treat early and properly to stop
the progression of pathology
![Page 32: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/32.jpg)
Treatment
Principles of treatment: Analgesia an general supportive measures. Rest of the affected part Antibiotic treatment. Surgical eradication of pus and necrotic tissue
(debridement).
![Page 33: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/33.jpg)
Treatment
Antibiotic treatment: Start with IV antibiotics for 2-3 weeks then oral for
3-6 weeks. Take cultures to detect the organism and its
sensitivity pattern. Start empirical treatment before culture result,
then modify treatment according to the result of culture and sensitivity
![Page 34: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/34.jpg)
Treatment
Antibiotic choices: Older children and adults (staph infection):
▪ fluloxacillin and fusidic acid. MRSA: Vancomycin Children younger than 4 year-old or those with
gram negative organisms:▪ 3rd generation cephalosporins.
Drug addicts and immuno-compromised patients: more specific antibiotics.
![Page 35: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/35.jpg)
Treatment
Surgery: If fever and local tenderness persist for more than
24 hour after adequate antibiotic treatment.▪ Drilling, drainage of pus and debridement of bone and
removal of sequestrum
![Page 36: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/36.jpg)
Treatment
Removal of implants and prosthesis: If they become unstable after
a trauma. Or intractable infection
following joint replacement. Severe cases may lead to the
loss of a limb.
![Page 37: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/37.jpg)
Follow-Up
Clinical symptoms and signs Repeat WBC and ESR
Should return to normal levels Follow up films
radiologic recovery slower than clinical recovery
![Page 38: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/38.jpg)
Complications
Bacteremia and metastatic infection Septic arthritis of neighboring joint Pathological fracture Altered bone growth Loosening of the implant:
fixation / prosthesis Bone abscess Chronic osteomyelitis
![Page 39: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/39.jpg)
Complications
Chronic Osteomyelitis
http://digitalmedicine.com.np/
![Page 40: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/40.jpg)
Special consideration
Chronic Osteomyelitis in Diabetic foot Poor sensation Poor blood supply Poor resistance Poor healing
Jose R. Jimenez MD, UTHCT
![Page 41: Prof. Mamoun Kremli. Osteomyelitis Osteo: bone, myelo: bone marrow, itis: inflammation An inflammation of the bone caused by an infecting organism](https://reader035.vdocuments.site/reader035/viewer/2022062309/56649e855503460f94b88277/html5/thumbnails/41.jpg)
Summary - Osteomyelitis
What is osteomyelitis Etiology Pathology Investigations and diagnosis Treatment
http://www.sarcoma.org/pathology