Osteomylitis

Def:
Inflammation of bone and bone-marrow due to infection
caused by various organisms.

 Pyogenic : Staph Aureus

 Non Pyogenic : Mycobacterium Tuberculosis

Mycobaterium Tuberculosis involving the Vertebra called Potts

disease

Classification according to mechanism of Infection

 Hematogenous spread ( Most common in children )

 Infection from Neighbouring soft tissue ( diabetic foot)

 Direct implantation of organism through

Penetrating injuries
Surgery ( Implantation)
Compound Fractures
Pathophsyiology :

Hematogenous spread:

Nutrient artery → Ascending and decending branches → branches

to cortex and Bone Marrow → Metaphyseal branches

Blood flow is slow and turbulent in metaphyseal branches so more

chances of organism to adhere to the bone and multiply there
and cause the infection ( metaphyseal Osteomylitis )

Most commonly in the children

Mainly affecting long bones of Children
Pus : Protein Rich inflammatory exudate having dead or alive
Microbes , leukocytes and local cells

Children >1 year of age have no vascular communication

between epiphysis and metaphysis

Infants <1 year of age having some vascular communication

between epiphysis and metaphysis so having more chances to
spread infection to epiphysis which can destroy articular
cartilage by causing suppurative arthritis and can damage the
joint permanently
Always treat suppurative arthritis on urgent bases in infants

Classification of Osteomylitis according to Duration :

 Acute : < 2 week
 Subacute : 2 week - 6 week
 Chronic : > 6 week ( sequestrum ( necrotic bone ), abcess
oozing from sinus )
Cierny & Mader Classification of Osteomylitis:

Type 1: Medullary → limited to medullary canal

Type 2 : superficial infection -limited to to exterior to bone

and does not penetrate cortex

Type 3 : Permeative/Stable (localized)- infection penetrate

through bone cortex of bone but is axially stable

Tyupe 4: permeative/ Unstable(diffused)- infection throughout

the bone in segmental fashion with axial instability

Host patient factor

Type A : Normal Physiological Host

Type B: Systemic Compromise( Diabetes Melitus, Renal or hepatic

failure)
Local Compromise ( smoking, Venus stasis)

Both Systemic and local compromise

Type C : Treatment Morbidity worse the present condition

Clinical feature :

 Limping
 Refusal to walk
 Fever /malaise
 Tender affected Joint
 Joint stiffness
 Draining sinuses + bone deformity in sub-acute and chronic
Osteomylitis

Differential Diagnosis

 JIA
 Acute Lukemia
 Osteoid Osteoma
 Osteosarcoma
 Subcutaneous abcess
 Child Abuse
 Scurvy
 Investigation :
 CBC: ↑TLC
 C Reactive Proteins ↑
 ESR ↑
 Blood culture
 X-ray affected Joint

MRI

A= Plain
B= post contrast
Aute Ostemylitis of 4 years old child

Periosteal enhancment

Bone Scan ↑ osteoblastic activity

 Bone Aspiration Culture

Treatment :

Medical care:
 I/V Antibiotics ( vancomycine Clindamycine , Nafciline )
Until C reactive protein doesn’t become normal

Surgical treatment :
 Irrigation and debridement of affected joints
 Splintage
 Physio therapy

Complications :

 Pathological Fractures
 Septic Arthritis
 Bone Sarcoma
 Sq Cell Carcinoma
 Marjolin Ulcer
 Infective Endocarditis
 Systemic Amyloidosis ,

Systemic amyloidosis :

Reactive arthritis → Chronic Inflammation → Poduce IL-1 IL6

→Hepatocytes → Serum Amyloid Associated
Proteins (AA)→Phagocytosed by reticular
endothelial cells →not properly degraded → AA
proteins ( misfoldedproteins ) → Aggregate in
different body organs ( eg: accumulate in
kidneys and cause nephrotic syndrome )