Osteomyelitis

Eric Umban

Anatomy and Physiology The Skeleton The adult human skeleton has a total of 206 bones, excluding the sesamoid bones (1). The appendicular skeleton has 126 bones, axial skeleton 60 bones, and auditory ossicles six bones. Each bone constantly undergoes modeling during life to help it adapt to changing biomechanical forces, as well as remodeling to remove old, microdamaged bone and replace it with new, mechanically stronger bone to help preserve bone strength.

Four general categories bones: 1. 2. 3. 4. Long bones (clavicle, humerus, radius, etc.) Short bones (carpal, tarsal bone) Flat bones (skull, mandible, scapulae) Irregular bones (sacrum, coccyx)

Function of Bone
-the bones of the skeleton provide structural support for the rest of the body -permit movement and locomotion by providing levers for the muscles

-protect vital internal organs and structures

-provide maintenance of mineral homeostasis and acid-base balance -serve as a reservoir of growth factors and cytokines, and provide the environment for hematopoiesis within the marrow spaces

The long bones are composed of a hollow shaft, or diaphysis; flared, cone-shaped metaphyses below the growth plates; and rounded epiphyses above the growth plates. The diaphysis is composed primarily of dense cortical bone, whereas the metaphysis and epiphysis are composed of trabecular meshwork bone surrounded by a relatively thin shell of dense cortical bone.

 Osteomyelitis

osteo-derived

from the osteon, meaning bone myelo- means marrow itis- means inflammation

Greek

word

Simply means an infection of the bone or bone marrow. It can be usefully sub classified on the basis of the causative organism(pyogenic bacteria or mycobacteria ) the route, duration and anatomic location of the infection . It is an acute or chronic inflammatory process of the bone and its structures secondary to infection with pyogenic organisms.

The

bones becomes infcted by one the three modes: 1. Extension of the soft tissue infection (incisional infection or vascular ulcer) 2. Direct bone contamination from bone surgery, open fracture, or traumatic injury 3. Hematogenous (blood borne) spread form other sites of infection

 Osteomyelitis

resulting from hematogenous spread typically occurs in a bone area of trauma or lowered resistance, possibly from subclinical (non apparent) trauma. Patient who are risk for osteomyelitis include those who are poorly nourished , elderly or obese. Also at risk are patient with impaired immune system, those with chronic illness and those receiving long term corticosteroid therapy. Postoperative surgical wound infections occur within 30 days after surgery. They are classified as incisional or deep .

Bone

infections are more difficult to eradicate than soft tissue infection because the infected bone becomes walled off. Natural body immune responses are blocked, and there is less penetration by antibiotics . Osteomyelitis may become chronic and may affect the patient's quality of life.

Etiology Bacteria Staphylococcus Aureus Streptococcus Gonococcus Cocciloides Treponema

Risk Factor

Long term use of corticosteroids Obese

Elderly
Poorly nourished Postoperative surgical wound

Trauma
Weak immune system Immunocompromised patient Diabetes Poor blood supply

Causes

Direct or indirect invasion of an organism into the bone

Break in the skin (break make cause abrasion, open fracture) Trauma to the bone

Category of Osteomyelitis

Exogenous- infectious organism enter from the outside of the body

Endogenous- organism carried by a blood circulation from other area of the infection in the body

Contigious- results from the skin infection of adjacent tissue

Sign and Symptoms:

Elevated WBC

Limited ROM
Bone pain on affected site Irritability

Elevated ESR
Swelling Redness

Modifiable Factor: Lifestyle Punctured wound

Non- Modifiable Factor: Age Gender

Bacterial invasion or infection on the wound

Hematogenous spread of infection to the bone Organism invade the bone tissue and initiate and inflammation response

Fever, Leukocytosis, Inflammation, and Pus formation

Exudates contribute to grow Pressure develops at the site causing pain Exudates extends into the medullary cavity and under the periosteum Sequestrum then osteoblastic response

Vascular Engorgement due to inflammation Compromised blood flow

Involucrum

Diagnostic Test: 1. 2. 3. 4. 5. 6. 7. Bone biopsy MRI CT-scan Ultrasound Culture and sensitivity CBC X-ray

Medical Intervention:
1. 2. 3. 4. 5. IVF (D5 0.3NaCl) Laboratory Test Medication (Paracetamol) Diet and Nutrition Debridement

Surgical Management:
1. Sequestrectomy 2. Bone graft 3. Muscle Flap 4. Amputation

Nursing Management: 1. Prevention for deformity or injury 2. Increasing clients comfort 3. Avoids complication of impaired mobility 4. Maintain cool and clean environment 5. Encourage on relaxation and distractive techniques 6. Provide information regarding to the disease 7. Open draining wounds 8. Administering oral antibiotics 9. Proper disposal of drainage 10. Emphasize importance of clean wound according to its disease

Nursing Diagnosis 1. Risk for peripheral neurovascular dysfunction 2. Risk for Infection 3. Acute pain 4. Impaired physical mobility 5. Impaired skin integrity