RESPONSIOSTEOMYELITIS

Pebimbing:dr. Erwien Isparnadi, Sp.OT

SMF BEDAH RSU HAJI SURABAYA FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG

2015

Disusun oleh:Maulana Saputra (201410401011007)

PENDAHULUAN

Osteomyelitis is an inflammation of the bone caused by a bacterial infection.

The incidence of Osteomyelitis range between 0,1 to 1,8% of the adult population.

The mortality of osteomyelitis ± 5-25%.

DEFINITION

• Osteomyelitis is an acute or chronic inflammatory process of the bone and its structures due to infection by pyogenic bacteria.

Epidemiologi

• 50% osteomyelitis occurs in children less than 5 years.

• 10-30% acute osteomyelitis progressed to chronic osteomyelitis.

ETIOLOGI

Staphylococcus aureus

(89-90%)

Escherichia coliPseudomonas

Klebsiella

PATOFISIOLOGI

osteomielitis

Hematogen

lokal

KLASIFIKASI

Cierney dan Mader

GAMBARAN KLINIS

General• Fever • Malaise• Nausea• AnoreksiaLocali• Painful• Edema• Hiperemi

Diagnosis

• Anamnesis• Physical diagnostic• Radiologi• Kultur

RADIOGRAFI

Reaksi periosteal osteolisis distal metatarsal IV dan distal phalanges III IV

RADIOGRAFI

Deformitas femur Sklerosis sumsum

RADIOGRAFI

MRI femurInhomegenitas

DIFERENSIAL DIAGNOSIS

• Arthritis Supuratif Acute• Osteosarcoma

Therapi

• Antibiotic• Antipiretik• Fluid• Debridement

15

16

COMPLICATION

17

Septikemia Artritis Supuratif

Osteomyelitis Kronik

Fraktur Patologis

PROGNOSIS

18

• Mortalitas osteomyelitis ± 5-25%.

• 10-30% acute osteomyelitis progressed

to chronic osteomyelitis.

CASE REPORT• Name : Tn. Sumarno• Ages : 50 tahun• Gender : Laki-laki• Address : Tambak Pondok

Legi II/B Surabaya• Religions : Moeslem• Ethnic : Jawa• Educational : Elementary

School• Occupation : Driver • No. register : 698751

ANAMNESISPain in the thigh knee

Patient came with Pain in the left thigh since one

year ago, the pain worse at late 4 month. Firstly

there was knee swelling and redness appearing on

his left thight and the patient felt pain. The pain was

intermittent in late 4 months. The pain increased

when the patient walking. Patient used tawon oil but

there was no effect. Sometimes patient felt his body

temperature elavated. one year ago, patient has

done fracture surgery on his left thigh.

Past Medical History

• DM (-)• HT(-)• Alergic (-)• Asma (-)

Phisical Examination

General condition : Fine Vital Sign• BP : 120/70 mmHg• N : 78 x/minutes• RR : 17 x/minutes• t : 36,30 C

• K/L : A/I/C/D -/-/-/- , palpebral oedem (–), rinorhea (-), otorhea (-), periorbital hematome (-).

• Thorax : Pulmo: I : normochest, (-)P : symmetric expantion

P : sonor/sonorA : VBS +/+ , ronchi -/-, wheezing -/-

Cor: I : IC (-)P : thrill (-)P : cardiac border: normalA : S1S2 single, murmur (-), gallop (-)

• Abdomen :I : Flat, symmetricP : Soepel, tenderness (-)P : Tympani, meteorismus (-)A : bowel (+) normal

• Ekstremitas: AKHM +/+

+/+

Oedem -/- -/+

REGIO FEMUR SINISTRA:

• Look: hyperemi (+), edema (+)ulcus (-), fistule (-), pus (-)

• Feel: calor (+), crepitate (-), pain (+)

• Move: ROM limited

X-Ray :sklerotic distal os femur.Osteophyte at medial condylus et lateral tibia and supero-infero posterior margo os patella.Fracture (-)Osteolitik/blastik (-)Soft tissue swelling (-)

Chronic osteomyelitis et femur distal S

– Diagnosis Planning : DL

– Diagnosis: Chronic Osteomyelitis 1/3 Femur Distal sinistra

– Therapy:

1. Wound Toilet2. MedikamentosaCefixime 2 x 100 mg and

Paracetamol 3 x 500 mg