8/9/2019 Acute and Chronic Osteomyelitis

1/19

Acute and chronic osteomyelitisPembimbing

Dr.Jafri Hasan, SpOT

Nur Hami ah Hashim!!."#!"."$%

8/9/2019 Acute and Chronic Osteomyelitis

2/19

Definition

• Acute osteomyelitis – &nfections of the bone

• Acute Hematogenous osteomyelitis – A rapidly de'eloping blood borne bacterial infection of

bone and its marro(

• )hronic osteomyelitis – bone infection predicated on pree*isting osteonecrosis

8/9/2019 Acute and Chronic Osteomyelitis

3/19

+pidemiology of acuteosteomyelitis

• ost fre-uently inthe long bones

• / 0 !

8/9/2019 Acute and Chronic Osteomyelitis

4/19

+tiology of acute osteomyelitis

• Portal of entry – Scratches, abrasions

etc –

ucous membrane ofrespiratory tract – 1ocal trauma

2#3

!#3

staphylococcus aureus streptococcus andpneumococcus

8/9/2019 Acute and Chronic Osteomyelitis

5/19

Patogenesis of acute osteomyelitis

8/9/2019 Acute and Chronic Osteomyelitis

6/19

8/9/2019 Acute and Chronic Osteomyelitis

7/19

Symptoms

• High fe'er and chills 4may beabsent in infants5

• S(elling, redness and (armtho'er the infected area

• 6estricted range of mo'ement inthe affected area

• &f osteomyelitis de'elopsfollo(ing an in7ury then thesymptoms may include puscoming out from a (ound

•

&rritability in young children• 8eneral discomfort, malaise,uneasiness

8/9/2019 Acute and Chronic Osteomyelitis

8/19

Diagnosis

• 1eucocytes count increase• 9:ray (ill be seen normal

in the ! st (ee;•

8/9/2019 Acute and Chronic Osteomyelitis

9/19

Treatment

• Supporti'e measures> eg intra'enous fluid• 6emo'able splint to pre'ent fractures• =road spectrum antibiotics•

Surgical decompression 4after "$ hours ofintensi'e treatment (ithout impro'ement5 – Drilling of bone – +'acuation of the subperiosteal pus

8/9/2019 Acute and Chronic Osteomyelitis

10/19

Prognosis

• Depends on – Time inter'al bet(een the onset of infection and the

treatment – The effecti'eness of the antibiotics and the causati'e

bacteria – The dosage of the antibacterial drugs

8/9/2019 Acute and Chronic Osteomyelitis

11/19

)omplications

• +arly – Death from septicemia – Abcess formation – Septic arthritis

• 1ate – )hronic osteomyelitis – Pathological fracture – Joint contracture –

1ocal gro(th disturbance

8/9/2019 Acute and Chronic Osteomyelitis

12/19

Chronic HematogenousOsteomyelitis

8/9/2019 Acute and Chronic Osteomyelitis

13/19

)hronic hematogenousosteomyelitis

• &nade-uate treatment of acute phase – ?ailure to diagnose acute osteomyelitis – ?ailure to pro'ide effecti'e antibacterial therapy – ?ailure to inter'ene surgically (hen indicated in the acute

phase

8/9/2019 Acute and Chronic Osteomyelitis

14/19

Pathogenesis

?ormation of a se-uestrum 4A5,sound bone> 4=5, ne( bone> 4)5,

granulations lining in'olucrum>4D5, cloaca> 4+5, se-uestrum

8/9/2019 Acute and Chronic Osteomyelitis

15/19

)linical features

• S(elling• Tenderness• 1oss of function•

aybe one or more draining sinuses

8/9/2019 Acute and Chronic Osteomyelitis

16/19

Diagnosis

• 6adiography – Presence of

se-uestra –

=rodie@s abcess

8/9/2019 Acute and Chronic Osteomyelitis

17/19

Treatment

• +*trudedspontaneously througha cloaca

• Se-uestrectomy• Sauceri ation

– the e*ca'ation of tissue toform a shallo( shel'ingdepression, usuallyperformed to facilitatedrainage from infectedareas of bone.

8/9/2019 Acute and Chronic Osteomyelitis

18/19

)omplications

!. Joint contracture". Pathological fracture0. Amyloid disease

$. alignancy of the epidermis4epidermoidcarcinoma5

8/9/2019 Acute and Chronic Osteomyelitis

19/19