Osteomylitis Ortho.report

7/30/2019 Osteomylitis Ortho.report

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Reported by:

Sr. Jinggle U. Emata

John Erick S Enero

Calamba Doctors College


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I-DEFINITION

Osteomyelitis is an infection

of the bone.


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TYPES:

Acute osteomyelitis - the infection develops within twoweeks of an injury, initial infection, or the start of an

underlying disease.

Sub-acute osteomyelitis - the infection develops within one

or two months of an injury, initial infection, or the start of anunderlying disease.

Chronic osteomyelitis - the bone infection starts at least

two months after an injury, initial infection, or the start of an

underlying disease.


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II-CAUSES

caused by staphylococcus bacteria

Germs can enter a bone in a variety of ways, including:

Via the bloodstream

From a nearby infection

Direct contamination

A bone fracture, some injury, or a complication of orthopedic

surgery may result in a bone infection.

The bone infection may be caused by a pre-existing condition,

such as diabetes.


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Bone infections are divided into several types, including:

Hematogenous osteomyelitis - the infection travels through the bloodstream.

Post-traumatic osteomyelitis - these are bone infections that occur after trauma, such

as a compound fracture (broken bone that breaks the skin), or an open wound to

surrounding skin and muscle.

Vascular deficiency - people with poor blood circulation may develop an infection from

a seemingly minor scrape or cut, usually on the feet.

Vertebral osteomyelitis - this is osteomyelitis that occurs in the spine. It usually starts

with an infection in the bloodstream, but can also be the result of surgery or trauma


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III-SIGNS AND SYMPTOMS

Fever or chills

Irritability or lethargy in young children

Pain in the long bone

Local Swelling, warmth and redness overthe areaof the infectionNausea

Malaise

Tenderness and swelling around theaffected boneLost range of motion

Drainage of pus in the skin


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IV-DIAGNOSTIC TEST

Blood tests-reveal elevated levels of white blood cells and other factors thatmay indicate that your body is fighting an infectionImaging tests

X-rays can reveal damage to your bone.Computerized tomography (CT) scan. combines X-ray images taken from

many different angles, creating detailed cross-sectional views of a person's

internal structures.

Magnetic resonance imaging (MRI). Using radio waves and a strong

magnetic field, MRIs can produce exceptionally detailed images of bones and the

soft tissues that surround them.Bone biopsy is the gold standard for diagnosing osteomyelitis, because it can

also reveal what particular type of germ has infected your bone.


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V- MEDICAL

MANAGEMENT

Hyperbaric oxygen therapy- uses

a special chamber, sometimes

called a pressure chamber, to

increase the amount of oxygen inthe blood.

Amputation

Implantation of antibiotic beads

I & D


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VI-SURGICAL

MAGEMENT

Sequestrectomyremoval of

Sequestra.Saucerization- to promote

drainage


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VII-NURSING

MANAGEMENT

Focus care on controlling infection, protecting the bone from injury, and

providing support.Encourage the patient to verbalize his concerns about his disorder.

Encourage the patient to perform as much self-care as his conditionsallows.Help the patient identify care techniques and activities that promote rest

and relaxation and encourage him to perform them.Use strict aseptic technique when changing dressings and irrigating

wounds.Provide a well-balanced diet to promote healing.

Support the affected limb with firm pillows


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Provide thorough skin care.

Provide complete cast care.

Administer prescribed analgesics for pain.

Assess vital signs, observe wound appearance, and note any mewpain which may indicate secondary infection.Watch for signs of pressure ulcer formation.

Look for sudden malpositioning of the affected limb, which may

indicate fracture.

Explain all the test and treatment procedures.

Cont


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VIII-PROGNOSIS

Foracute osteomyelitis is very good

Forchronic osteomyelitis, which is more prevalent in

adults, the prognosis is still poor.


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I-DEFINITION

A medical condition in which

the bones become brittle andfragile from loss of tissue,

typically as a result of

hormonal changes.


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There are two main types of osteoporosis: primary and secondary.

Primary osteoporosis- occurs most commonly in women after menopause.

Osteoporosis affects twice as many females over the age of 70 years as males in the

same age group.

Secondary osteoporosis- can affect young and middle-aged people as well. It may

be caused by:

medications such as corticosteroids (e.g., prednisone*)chronic illnesses such as anorexia nervosa (an eating disorder that leads to

malnutrition)

Too much exercise - women who exercise excessively may lose their menstrual cycle

and the normal production of estrogen by the ovaries may stop


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II-CAUSES

PRIMARY OSTEOPOROSIS:Mild but prolonged negative

calcium balance

Inadequate dietary intake ofcalciumDeclining gonadal or adrenal

function

Faulty protein metabolism due to

estrogen deficiencySedentary lifestyle

SECONDARY OSTEOPOROSIS:Prolonged therapy with steroids or

heparinCigarette smoking

Total immobilization or disuse of

bone

Alcoholism, Malnutrition,

Malabsorption, Celiac disease,scurvy, lactose intolerance.Osteogenesis imperfect, sudecks

atrophy


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III-SIGNS AND

SYMPTOMS

Vertebral collapse

Causing a backache with pain that

radiates around the thrunkIncreasing deformity

Kyphosis

Spontaneous wedge fractures

Pathologic fractures of the neck or

femurLoss of height

Bones weaken


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IV-DIAGNOSTIC TEST

Bone mineral density testing- measures

the mineralization of the bone.Spine computed tomography-shows

demineralization.X-rays- show fracture or vertebral collapse

in severe cases.

Urine calcium- can provide evidence bone

turnover but is limited in value


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V- MEDICAL

MANAGEMENT

Medications:

BiphosphonatesAlendronate

Risedronate

Adequate calcium and vitamin

D intakeRaloxifene and calcitonin


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VI-SURGICAL MAGEMENT

Osteoporosis Surgery:

Vertebroplasty-is a minimally invasive procedure used to reinforce vertebrae with

compression fractures, which are common in patients with osteoporosis.Vertebroplasty

involves injecting an acrylic compound into the collapsed vertebra to stabilize the weakened

bone. The procedure is performed in an operating room or radiology suite and treatment of

each affected vertebra takes

approximately 1 hour.

Kyphoplasty-Multiple spinal compression fractures caused by osteoporosis may lead toheight loss, kyphosis (extreme curvature of the spine), and pain. Kyphoplasty, also called

balloon kyphoplasty, is a minimally invasive procedure that is used to restore the height ofthe vertebrae and stabilize weakened bone.


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VII-NURSING

MANAGEMENT

Focus on careful positioning, ambulation, and prescribed exercises.

Administer analgesics and heat to relieve pain as ordered.

Include the patient and his family in all phases of care.

Encourage the patient to perform as much self-care as her immobility

and pain allow.Provide the patient activities that involve mild exercise.

Check the patients skin daily for redness, warmth, and new

painsites.


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ContMonitor the patients pain level, and assess her response to

analgesics, heat therapy, and diversional activities.

Explain all treatments, tests, and procedure to the patient.

Make sure the patient and her family clearly understand the prescribed

drug regiman.Tell the patient to report any new pain sites immediately, especially

after trauma.Provide emotional support and reassurance to help the patient cope

with limited mobility.


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VIII-PROGNOSIS

The outlook for people with osteoporosis

is good, especially if the problem is

detected and treated early


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I-DEFINITION

TB of the spine with destruction of vertebrae resulting in curvature of

the spine.

Partial destruction of the vertebral bones, usually caused by a

tuberculous infection and often producing curvature of the spine.An old term fortuberculosisof thespine that caused softening and

collapse of thevertebrae, often resulting inkyphosis a "hunchback"deformity, which was called "Pott's curvature."

also known as Potts caries, David'sdisease,

andPott'scurvature,


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II-CAUSES

caused by

mycobacteriumtuberculosis.Partial destruction of the

vertebral bones, usuallycaused

by a tuberculous infectionand

often producing curvature of thespine.


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III- SIGNS AND

SYMPTOMS

back pain

fever

night sweating

anorexia

Spinal mass, sometimes

associated with numbness,paraesthesia, or muscle

weakness of the legs


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IV-DIAGNOSTIC

TEST

Blood tests

- CBC: leukocytisis elevatederythrocyte sedimentation rate>100 mm/h

The Mantoux Test (Tuberculin Skin Test)

Injection of a purified protein derivative (PPD). Results are positive in 84-95% ofpatients with Potts disease who are not infected with HIV.

Erythrocyte Sedimentation Rate (ESR)

ESR may be markedly elevated (>100 mm/h)

Microbiology studies- are used to confirm diagnosis. Bone tissue or abscess

samples are obtained to stain for acid-fast bacilli (AFB), and organisms are isolated for

culture and susceptibility.Radiography- Radiographic changes associated with Potts disease present relatively

late.

CT scanning provides much better bony detail of irregular lytic lesions, sclerosis, disk

collapse, and disruption of bone circumference.


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V-MEDICAL

MANAGEMENT

Anti-Tuberculosis Chemotherapy

Surgical Drainage of Abscess

Surgical Spinal Cord

DecompressionSurgical Spinal Fusion

Spinal Immobilization


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MEDICATIONS:

Isoniazid (Laniazid, Nydrazid)

Rifampin (Rifadin, Rimactane)

Pyrazinamide

Ethambutol (Myambutol).

Streptomycin

Cont


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VI-SURGICAL

MANAGEMENT

Richards intramedullary hip screw -

facilitating for bone healingKuntcher Nail - intramedullary rod

Austin Moore - intrameduallary rod (for

Hemiarthroplasty) Surgery includes ADSF (

Anterior Decompression Spinal Fusion).


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VII-NURSING

MANAGEMENT

Investigate report of pain, noting characteristics, location, intensity (0-10

scale).Provide firm mattress and small pillows.

Suggest patient assume position of proper comfort while in bed or chair.Promote bed rest as indicated.

Encourage frequent changes of position.

Apply warm or moist compression the affected area severalties a day

Provide gentle massage

Encourage use of stress management techniques.Administer no steroidal anti-inflammatory drugs as prescribed.

Administer anti-biotic as prescribed


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VII-PROGNOSIS

The progress is slow and lasts for months or even years.

Prognosis is better if caught early and modern regimes of

chemotherapy are more effective.


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REFERENCES:

Professional guide to disease 9th edition Lippincott Williams and Wilkins

http://www.medicinenet.com/osteomyelitis/article.htm

http://www.fpnotebook.com/ortho/ID/OstmyltsMngmnt.htmfaculty.uoh.edu.sa/b.hijah/documents/Osteomyelitis.ppt

medical-dictionary.thefreedictionary.com/osteoporosis

www.spine-health.com ConditionsOsteoporosis


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