Lec 3 pathology

Chronic non-specific osteomyelitis

• Def:
Chronic non-specific inflammation of the bone (osteitis) and bone marrow (myelitis).
• Etiology:
-Causative organisms:
Usually bacterial: Staphylococcus aureus (most common).May be fungal
-Predisposing factors: Follows untreated or inadequately treated acute suppurative
osteomyelitis. Occurs in 15-30% of cases.
Factors responsible for chronicity
 Local factors: cavity, sequestrum,sinus,foreign body
,degree of bone necrosis
 General: Nutritional status of the involved tissues
,vascular disease,DM,low immunity
 Organism: Virulence
 Treatment: Appropriateness and compluance
 Risk factor: penetrating trauma,prosthesis,animal bite
 Discuss pathogenesis,morphology, diagnosis and
complications of chronic osteomyelitis
Pathogensis
– cortical bone becomes necrotic (sequestrum) secondary to periosteal elevation resulting in an
inadequate blood supply.
- The infecting organisms may remain viable within the marrow cavity for many years with
potential sequestrum providing a nidus.
- There may be extensive bone destruction, marrow fibrosis and recurrent focal suppuration
(Brodie abscess).
- Reactive new bone formation is seen, particularly around and outside the inflamed periosteum
(involucrum), leading to a thickened and abnormally shaped bone.
- https://youtu.be/P9gO6sCzcnc

Pathological Features:
Site:
• occurs in the metaphysis of long bones (most common in children).
• Mostly in lower end of femur, both ends of tibia, upper end of humerus or lower end of radius
• Clavicle and vertebrae are more common in adults.

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Morphology:
• It is well circumscribed area of suppurative inflammation
which forms a cavity filled with pus and dead bone (sequestrum)
separated and surrounded by sclerosed bone (involucrum).
• Pus under pressure open into periosteal surface by
sinus openings called cloaca
microscopically:

• Neutrophils (may persist for weeks), lymphocytes and

plasma cells with bone necrosis and reactive new
bone formation
• Capillary proliferation and fibrosis
• Bone marrow space replaced by inflammatory tissue and late
get fibrosed
Complications:
1. Pathological fracture.
2. Nearby joint effusion.
3. Amyloidosis.
4. If neglected for years, sinus lining may develop
squamous cell carcinom

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Brodie’s abcess
1 st described as a form of Subacute
osteomyelitis.
 It is a small cavity filled with pus and
surrounded by sclerotic bone. The wall is
highly vascular.
 It occurs in conditions when immune response and organism
virulence are balanced.
 It is a low grade pyogenic abscess; no constitutional symptoms,
presents with mild to moderate dull intermittent pain.
 Some consider it a form of chronic osteomyelitis.

 Discuss TB osteomyelitis

Tuberculous of the bone

• TB infection of the skeleton occurs in 1%–3% of cases of pulmonary TB.
• It is usually due to hematogenous spread of tuberculous bacilli from the 1ry focus.
• May be direct spread from joint or soft tissue focus.
• It may spread to other sites either hematogenous or by lymphatics.
• It is usually solitary focus, but may be multifocal in immunocompromised patients.
sites
• Spread may be to any bone/joint.
• Weight bearing bones are more commonly affected.
• Spine is the commonest (pott’s disease).
• Hip, knee and foot come 2nd.
• Short bones and flat bones are rarely affected.
• Caseous necrosis causing bone destruction and not accompanied by adequate callus formation
(poor healing)

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Pott’s disease (tuberculosis of vertebrae)

• Mostly affects the lower thoracic and upper lumber vertebrae.
• Causing destruction of both the vertebral bodies and discs
• It exdends to the soft tissue forming cold abscess.
Complications of POTT’S disease
 Deformity : kyphosis
 Cold abcess: formed under the prevertebral fascia and
can spread
• At the cervical region: central retropharyngeal or at the posterior
border of sternomastoid
• At the thoracic region: posterior mediastinum.
• At the lumber region: lumbodorsal triangle.
 Paraplagia2 :ry to spinal cord and nerve compression

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Other sites for bone tuberculosis Gross picture

T.B of long bones:
• In metaphysis.
• Spread causing subperiosteal abcess or T.B artheritis
T.B of short bones (dactylitis)
• Short bones of hands and feet.
• Affects the diaphysis and the medullary canal.
T.B of flat bones:
• As sternum, ribs and pelvis.
• Causing subperiosteal cold abcess. Microscopic picture
morphology
• Tuberculous granulomas occur in the boney
haversian canals and marrow spaces.
• The bone undergoes destruction and resorption
and be replaced by caseous material (tuberculous caries)
• Periosteal new bone formation is minimal or absent.

Microscopically
 Discuss syphilitic osteomyelitis

Syphilitic osteomyelitis
• It occurs as a part of tertiary syphilis
• It may be localized affection (Gumma):
➢Causes bone destruction especially at the hard palate.
• May be a part of diffuse syphilitic inflammation:
➢Diffuse inflammation accompanied by bone thickening.
➢NO pathological fracture. Grossly
➢Long bone are more commonly affected.

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