OSTEOMYELITIS

Fatihah Anisah Bt Mukhtar 112012215

Definition
Osteomyelitis is an infection of the bone and or bone marrow. It can happen in any bone in the body, but it most often affects the long bones (femur, tibia, radius, ulna, fibula), vertebral, carpal and tarsal bones.

Anatomy & Function of the Bone

Functions: To support the bodys mass against gravity Act as shield against blunt or penetrating trauma for certain vital areas of the body (notably the heart (sternum) and brain (skull) To provide solid frame against which muscles can pull in order to provide mobility

Etiology
Depend on the age of the patient. Staphylococcus aureous most common in neonate Escherichia coli Group-B Streptococci Candida albicans Neisseria gonorhoeae most common in adolescents

Types & Pathogenesis of Osteomyelitis

1. Hematogenous
Originates from the bloodstream

2. Contiguous focus
Result from either direct introduction of the infective agent to the bone (traumatic injury) or from adjacent soft tissue infection (cellulitis)

Classification
Based on duration onset; Acute (less than 2 weeks) Subacute (2-6 weeks) Chronic (more than 6 weeks)

Hematogenous Osteomyelitis
20% of the total cases of osteomyelitis
Primary Hematogenous Predominant in infant & children Direct seeding of bone from infective agent present in the vasculature Secondary Hematogenous Predominant in adult Bacteria gain access to the bloodstream and clonize at the distal bone Reactivation of a dormant focus Individual suffered during infancy or childhood

 Usually located in long bones (tibia,ulna, radius,etc) or in vertebra and most often caused by single etiologic agent The lesion is usually closed to metaphysis

 Anatomical region of metaphysis, where the nutrient artery non-anastomosing & end at the metaphysis most frequently involved in osteomyelitis Trauma (infant or child) hematoma infection vascular obstruction bone necrosis

Symptoms presentation: Malaise Lethargy Fever Tenderness (at or above the site of infection) range of motion in the affected limb

Chronic Hematogenous Osteomyelitis

Acute and subacute osteomyelitis that left untreated More than 6 weeks Can be caused by orthopedic surgery (implant) that used to reposition the bones

 The involucrum an area of live, encasing bone surrounding infected dead bone within a compromised soft tissue envelope contain necrotic bone marrow & endosteal bone Hallmark sign of chronic osteomyelitis

BRODIE ABCESS

Clinical presentation: Ulcer Pus or fistel Malaise Fatigue

Contiguous Focus Osteomyelitis

Microbes being directly inoculated into the bone at the time of trauma Young individual trauma & surgery Older individual surgery & decubitus ulcer Damage of any sort of tissue in blood supply formation of necrotic areas of inert tissue binding of bacteria infection

The Staging System for Adult Osteomyelitis

ANATOMIC TYPE TYPE I TYPE II TYPE III TYPE IV Medullary Osteomyelitis Superficial Osteomyelitis Localized Osteomyelitis Diffuse Osteomyelitis PHYSIOLOGIC CLASS A-Host B-Host C-Host Good immune system and delivery Compromised locally (BL) or Systemically (BS) Requires suppressive or no treatment; minimal disability; treatment worse than disease ; not a surgical candidate

Treatment of Osteomyelitis
1. Antibiotic if possible, suits the type of bacteria 2. Debridement chronic osteomyelitis with abcess 3. General support care IV line, analgesic

Complication
Bone abcess Bacterimia Fracture Cellulitis Fistel

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