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Information about Osteomyelitis

Published on March 7, 2008

Author: ksbarot

Source: authorstream.com

Slide1:  OSTEOMYELITIS Slide2:  OSTEOMYELITIS INFLAMMATORY PROCESS IN BONE & BONE MARROW ACUTE & CHRONIC Slide3:  PATHOPHYSIOLOGY Hematogenous Osteomyelitis Contiguous-Focus Osteomyelitis Peripheral Vascular Disease-associated Slide4:  PATHOPHYSIOLOGY Microorganisms enter bone (Phagocytosis). Phagocyte contains the infection Release enzymes Lyse bone Slide5:  PATHOPHYSIOLOGY Bacteria escape host defenses by: Adhering tightly to damage bone Persisting in osteoblasts Protective polysaccharide-rich biofilm Slide6:  PATHOPHYSIOLOGY Pus spreads into vascular channels Raising intraosseous pressure Impairing blood flow Chronic ischemic necrosis Separation of large devascularized fragment New bone formation (involucrum) (Sequestra) Slide7:  PATHOLOGY Acute Infiltration of PMNs Congested or thrombosed vessels Chronic  Necrotic bone Absence of living osteocyte Mononuclear cells predominate Granulation & fibrous tissue Slide8:  Hematogenous Osteomyelitis Slide9:  HEMATOGENOUS OSTEPMYELITIS Rapidly growing bone Children: Long bone, Femur, Tibia, Humerus Older patients: Vertebral bone Slide12:  HEMATOGENOUS OSTEOMYELITIS Neonate & infant < 1 year old Septic arthritis is common. Growth deformities is common. Soft tissue involvement is common. Slide13:  HEMATOGENOUS OSTEOMYELITIS Children: 1 – 16 years old Most frequent in the metaphysis of long bone. Slugging blood flow through a sinusoidal venous system. Deficency of phagocytic cells. Poor collateral circulation Susceptibility of this region to trauma. Slide15:  HEMATOGENOUS OSTEOMYELITIS Children: 1 – 16 years old History of antecedent trauma in 30% Involucrum Sequestration Associated septic arthritis Slide16:  HEMATOGENOUS OSTEOMYELITIS Adult Less common Spread infection to joint space. Vertebral Osteomyelitis is common> 50y Slide18:  HEMATOGENOUS OSTEOMYELITIS Special consideration Sickle cell disease Injection drug users (IDUs) Hemodialysis HIV/AIDS Immunosuppression Prosthetic orthopedic device Slide19:  HEMATOGENOUS OSTEOMYELITIS Microbiologic features Staphylococci  Aureus, Epidermidis Streptococci  Group A & B Haemophilus influenzae Gram-negative enteric bacilli Anaerobes Polymicrobial Mycobacterial Fungi Slide20:  HEMATOGENOUS OSTEOMYELITIS Clinical manifestation Classic presentation: Sudden onset Usually presentation: Slow, insidious High fever, Night sweats Fatigue, Anorexia, Weight loss Restriction of movement Local edema, Erythema, & Tenderrness Slide21:  HEMATOGENOUS OSTEOMYELITIS Differentials Cellulitis Gas gangrene Neoplasm Aseptic bone infection Slide22:  Clenched fist osteomyelitis Slide23:  HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Lab study: WBC  May be elevated, Usually normal C-Reactive Protein (CRP) Erythrocyte Sedimentation Rate (Usually is elevated at presentation Falls with successful therapy) Blood culture ( Acute osteomyelitis + ve > 50% ) { Slide24:  HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging Radiology: Normal Soft tissue swelling Periosteal elevation Lytic change Sclerotic changew Slide25:  HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging MRI: Early detection Superior to plan X ray & CT Scan & radionuclide bone scan in slected anatomic location. Sensitivity 90 – 100% Slide26:  HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging Radionuclide bone scan: A 3-phase bone scan ( Technetium 99m ) Positive as early as 24 h after onset of symptoms. False positive  Tumor, osteonecrosis Artheritis, Cellulitis, Abscess Slide27:  HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging CT – Scan: Useful in evaluation of  Spinal, pelvic, Sternum, Calcaneus Provides exellent images of bone cortex Is used for biopsy localization Slide28:  Os + gaz in diabetic foot Slide30:  Septic arthritis Of Right hip Slide31:  HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Ultrasonography Simple & inexpensive Demonstration anomaly 1 – 2 days after onset Soft tissue abscess, Fluid collection, & Periosteal elevation It allows for aspiration It doesn’t allow for evaluation of bone cortex. Slide32:  HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Neddle Aspiration or Open biopsy: From: Soft tissue collection Subperiosteal abscess Intraosseos lesions For: Smear Culture Pathology Slide33:  TREATMENT Initial treatment shoud be aggressive. Inadequate therapy  Chronic disease Antibiotic use: Surgery Parenteral High doses Good penetration in bone Full course Empiric therapy Slide34:  TREATMENT Empiric Initial Therapy Neonate S.aureus PRP + Infant<2 y G –ve bacilli Cefotaxime Children S.aureus PRP + H.Infenza Ceftriaxone Adult S.aureus PRP or 1st ceph Slide35:  TREATMENT Indication for Surgery Diagnostic Hip joint involvement Neurologic complication Poor or no response to IV therapy Sequestration Slide36:  TREATMENT Monitoring Therapeutic Response Symptoms & Signs ESR & CRP Radiography Serial Bone Scan? Slide37:  PROGNOSIS Is related to: Causative organisms Duration of symptoms & sign Patient age Duration of antibiotic therapy Slide38:  COMPLICATION Bone abscess Bacteremia Fracture Loosing of the prosthetic implant Overlying soft-tissue cellulitis Draining soft-tissue tract Slide39:  Post Osteomyelitis Treatment Slide40:  Septic Osteomyelitis Post Osteomyelitis Scar Slide41:  Post Osteomyelitis Deformity of the Forearm Slide42:  CONTIGUOUS-FOCUS OSTEOMYELITIS Slide43:  Contiguous-focus Osteomyelitis Clinical setting: Postoperative infection Contamination of bone Contiguous soft tissue infection Puncture wounds Slide44:  Contiguous-focus Osteomyelitis Microbiologic features Staphylococci  Aureus, Epidermidis Gram-negative bacteria Anaerobic infection Unusual organisms Clostridia, Nocardia Slide45:  Contiguous-focus Osteomyelitis Diagnosis Leukocyte count Blood culture (infrequently positive) ESR & CRP Radiologic evaluation Technetium bone scan Open bone biopsy Culture of wound & draining sinuses?? Slide46:  Contiguous-focus Osteomyelitis Treatment Surgery is essential. Antibiotics  Specific Duration

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