Osteomyelitis Pus/fluid aspiration

Introduction Acute:
- More common in children 2. Imaging
- Most common organism: staphyloccous aureus i. Plain Xray:
Chronic: - Acute OM: initially no findings –later findings: subperiosteal
- Sequelae of acute OM, post-traumatic and post-op OM new bone formation, lytic region surrounded by sclerotic area
- Chronic OM: osteolytic lesion (moth eaten), sequestrum,
involucrum, cloaca and sinus, loss of trabeculation
History 1. Symptoms
ii. MRI and CT scan: planning operative treatment
- Swelling
- Shows extend of bone destruction and reactive edema, hidden
- Discharge sinus
abscesses and sequestra
- Deformity/shortening
- Unable to weight bear/loss of function
- Pain
- Systemic symptoms: fever, malaise

2. Duration
- <2 weeks: acute
- >2 weeks: chronic

3. Cause
- History of trauma: open fractures, operation involving implants
- History of joint infection, diabetic foot ulcer

4. Risk factors
- IVDU Cierny -Mader classification
- Immunocompromised: DM - Application of staging for the diagnosis and treatment of
- Malnutrition osteomyelitis
- Peripheral vascular disease

Physical General:
examination - Septic looking (acute)
Look:
- Scars, deformity (limb shortening)
- Sinus, discharge
- Exposed bone
- Surrounding skin
- External fixator
Feel:
- Warm, tender
- CRT, pulses
Move
- Reduced in acute OM Management Acute OM
- Supportive treatment
Investigations 1. Blood investigations • Pain management with analgesia
- Septic workup • Dehydration with IV fluid
FBC: raised white cell count - Splintage of affected part
CRP,ESR: raised - Antibiotic therapy
Blood C+S • Adults: flucloxacillin & fusidic acid (IV for 2 weeks + 4
weeks oral)
 • Gram negative: cephalosporin
- Surgical drainage – for subperiosteal abscess or persistent
pyrexia and local tenderness of >24h

Chronic OM:
- Antibiotic therapy
• Start as soon as culture samples obtained
• Fusidic acid or cephalosporin (2+4 weeks)
- Wound debridement (excise all dead bone & infected tissue)
- Obliteration of dead space
• Antibiotic-impregnated acrylic beads (PMMA) –
gentabeads
• <5cm: bone graft
• >5cm: bone transport + Ilizarov (distraction
osteogenesis)
- Soft tissue cover
• Smaller defect: SSG
• Larger wound: local musculocutaneous flap/
vascularized flaps
- Stabilization (if needed)