🔹
It is infection of the bone tissue
Causative organism:-
-Staphylococcus aureus (80%).
- Pneumococci.
- Genococci.
🔹
- Salmonella.
sites:
🔹
Usually at the metaphysis of long bones.
Most common sites:-
🔹
about the knee.
Age:
🔹
Childeren 3-15 years. Acute hematogenous
Sexs: it begin in metaphysis because of:
🔹
Boys > girls 1- high vascularity.
predisposing tactors : 2- end arterioles--> stasis.
Deintion: - Trauma. 3- less active phagocytosis.
-D.M 4- lack of endothelial lining in metaphyseal vessels.
-S.C.A 5- growing area.
🔹
- Measeles. 6- attachment of muscles & ligaments.
Classitcation According to the severty 7- more liable to trauma.
A- Acute.
B- Sub acute.
🔹
C- Chronic.
Pathogenesis Route of infection:
-Hematogenesis
-Direct inoculation
e.g •open fracture.
•nail puncture.
-Spread of contagious area of infection
e.g. septic arthritis
History of trauma, usually minor.
🔹
Hematoma formation
Spread of infection from any focus of infection
Infammatory process---->cellulites------>pus
formation Seeks the paths of least resistance --one
of 3 ways:
1- into diaphysis----->medulla (rare) vertical.
2- epiphysis -------->neonate.
3- exit the cortex------>subperiosteal pus (common)
🔹 subperiosteal pus----> destruction of periosteum
🔹
Soft tissue abscess --->penetrate muscles, skin-->Sinus.
Thrombosis of venous & arteries (endostum)---> elevation of
periosteum--->decrease supply to periosteum ---- dead avascular
🔹
bone (sequestrum)
In this way the elevated periosteum remains viable ----> produce
new bone (Involucrun)
LABORATORY
INVESTIGATIONS:
🔹 Blood;-
increase WBC, decrease Hb%,
increase ESR.
General Bood cuture positive in 50%,
symptoms & signs of sepsis:
febrile, pallor, loss of appetite, sweating, rapid puls, malaise. 🔹 X-rays finding negative in first 10
days.
Acute OM Locally
Redness, shiny, dilatation of blood vessels
Finding:
- Rarefaction.
Swelling. - Periosteal reaction (involcrum)
Clinical picture Sever localized tenderness. - sequstrum.
Hotness. - soft tissue opacity.
If pus formed----> fluctuation.
Restriction of movement. 🔹 MRI:
before x-ray:-
Swelling of adjacent joints.
Painful enlargment of regional lymph nodes. Odema, abscess,medullary extent
bone infection Sinus.
🔹 bone scan:
increase uptake.
🔹 Aspiration:
definitive diagnosis.
by fatema okoff
Criteria for diagnosis
1- Pus in aspiration.
2- +ve culture of blood & soft tissue.
3- Presence of classical signs & symptoms.
4- Radiographic change.
diagnosis
Differential diagndsis:
1 - Cellulitis.
2- Septic arthritis.
3- Rheumatic fever.
4-S.C.A.
General
🔹-combination
1) I.V antibiotics
of two.
-I.V for first 2week then oral for next 2 to 4weeks. (total 4 -6 weeks) Complication
(Oxacillin or Na fcillin) (itrative cefazolin) 1- Septicemia & toximia ---> cause of
death.
Treatment
🔹
Note : new-->3weeks IV then 3weeks oral.
🔹 2) Analgesics & Antipyretics 2- Septic arthritis.
3- Pathological fracture.
🔹 3) High protein diet
4)Vitamins. 4- Multiplicity.
5- Growth arrest of affected site.
6- Chronic osteomylitis.
Locally: 7- Amilodyosis in chronic.
1- Rest of the affected limb.
2- Incision & drainage
*swab for culture & sensitivity taken.
Sub acute it differ from acute osteomylitis in the severity of
haematogenous clinical signs.
The systemic signs are either absent or much less,
osteomylitis
definition:
Its osteomylitis presenting with symptoms that have In chronic there is:
been present for months or longer, and any recurrent - sequestrum.
osteomylitis. - involucrum.
Causes; - bone thickening.
inadequate or bad management of - bone deformation.
acute osteomylitis. - multiple or single sinus discharging pus.
Causative agent:-
same as acute.
🔹
Clinical pictures
🔹 long history
less systemic signs.
Local :-
localized deep pain.
swelling.
sinus discharging pus.
X-rays
- sequestrum (multiple)
- involucrum.
- Honey comb --> multiple cavities filled with pus & sequestrum. - Acute flare up.
Clinical pictures *CT, MRI, bone scan can also help in some doubtful Complication - Squameus cell carcinoma.
cases. - Amyloid disease.
Chronic
osteomylitis
🔷 Always surgical with antibiotic.
1- sequestrectomy:
TREATMENT excision of dead bone and dead soft tissue.
2- saucerization:
curettage of cavities to promote new bone formation.
It is special type of chronic osteomylitis. -salmonella osteomylitis in S.C.A &
It's occur when resistance of patient is high and typhoid osteomylitis.
the micro-organism with low virulence. -Fungus osteomylitis in madura foot
It is localized infection within bone. (Actinomycosis)
Boride's abscess C.P:
no systemic signs.
localized deep pain.
X-ray:
localized oval cavity (translucent) surrounded
by sclerotic bone, in the metaphysis.
Treatment:
saucerization.
It is infection of the bone tissue
Causative organism:-
-Staphylococcus aureus (80%).
- Pneumococci.
- Genococci.
🔹
- Salmonella.
sites:
🔹
Usually at the metaphysis of long bones.
Most common sites:-
🔹
about the knee.
Age:
🔹
Childeren 3-15 years. Acute hematogenous
Sexs: it begin in metaphysis because of:
🔹
Boys > girls 1- high vascularity.
predisposing tactors : 2- end arterioles--> stasis.
Deintion: - Trauma. 3- less active phagocytosis.
-D.M 4- lack of endothelial lining in metaphyseal vessels.
-S.C.A 5- growing area.
🔹
- Measeles. 6- attachment of muscles & ligaments.
Classitcation According to the severty 7- more liable to trauma.
A- Acute.
B- Sub acute.
🔹
C- Chronic.
Pathogenesis Route of infection:
-Hematogenesis
-Direct inoculation
e.g •open fracture.
•nail puncture.
-Spread of contagious area of infection
e.g. septic arthritis
History of trauma, usually minor.
🔹
Hematoma formation
Spread of infection from any focus of infection
Infammatory process---->cellulites------>pus
formation Seeks the paths of least resistance --one
of 3 ways:
1- into diaphysis----->medulla (rare) vertical.
2- epiphysis -------->neonate.
3- exit the cortex------>subperiosteal pus (common)
🔹 subperiosteal pus----> destruction of periosteum
🔹
Soft tissue abscess --->penetrate muscles, skin-->Sinus.
Thrombosis of venous & arteries (endostum)---> elevation of
periosteum--->decrease supply to periosteum ---- dead avascular
🔹
bone (sequestrum)
In this way the elevated periosteum remains viable ----> produce
new bone (Involucrun)
LABORATORY
INVESTIGATIONS:
🔹 Blood;-
increase WBC, decrease Hb%,
increase ESR.
General Bood cuture positive in 50%,
symptoms & signs of sepsis:
febrile, pallor, loss of appetite, sweating, rapid puls, malaise. 🔹 X-rays finding negative in first 10
days.
Acute OM Locally
Redness, shiny, dilatation of blood vessels
Finding:
- Rarefaction.
Swelling. - Periosteal reaction (involcrum)
Clinical picture Sever localized tenderness. - sequstrum.
Hotness. - soft tissue opacity.
If pus formed----> fluctuation.
Restriction of movement. 🔹 MRI:
before x-ray:-
Swelling of adjacent joints.
Painful enlargment of regional lymph nodes. Odema, abscess,medullary extent
bone infection Sinus.
🔹 bone scan:
increase uptake.
🔹 Aspiration:
definitive diagnosis.
by fatema okoff
Criteria for diagnosis
1- Pus in aspiration.
2- +ve culture of blood & soft tissue.
3- Presence of classical signs & symptoms.
4- Radiographic change.
diagnosis
Differential diagndsis:
1 - Cellulitis.
2- Septic arthritis.
3- Rheumatic fever.
4-S.C.A.
General
🔹-combination
1) I.V antibiotics
of two.
-I.V for first 2week then oral for next 2 to 4weeks. (total 4 -6 weeks) Complication
(Oxacillin or Na fcillin) (itrative cefazolin) 1- Septicemia & toximia ---> cause of
death.
Treatment
🔹
Note : new-->3weeks IV then 3weeks oral.
🔹 2) Analgesics & Antipyretics 2- Septic arthritis.
3- Pathological fracture.
🔹 3) High protein diet
4)Vitamins. 4- Multiplicity.
5- Growth arrest of affected site.
6- Chronic osteomylitis.
Locally: 7- Amilodyosis in chronic.
1- Rest of the affected limb.
2- Incision & drainage
*swab for culture & sensitivity taken.
Sub acute it differ from acute osteomylitis in the severity of
haematogenous clinical signs.
The systemic signs are either absent or much less,
osteomylitis
definition:
Its osteomylitis presenting with symptoms that have In chronic there is:
been present for months or longer, and any recurrent - sequestrum.
osteomylitis. - involucrum.
Causes; - bone thickening.
inadequate or bad management of - bone deformation.
acute osteomylitis. - multiple or single sinus discharging pus.
Causative agent:-
same as acute.
🔹
Clinical pictures
🔹 long history
less systemic signs.
Local :-
localized deep pain.
swelling.
sinus discharging pus.
X-rays
- sequestrum (multiple)
- involucrum.
- Honey comb --> multiple cavities filled with pus & sequestrum. - Acute flare up.
Clinical pictures *CT, MRI, bone scan can also help in some doubtful Complication - Squameus cell carcinoma.
cases. - Amyloid disease.
Chronic
osteomylitis
🔷 Always surgical with antibiotic.
1- sequestrectomy:
TREATMENT excision of dead bone and dead soft tissue.
2- saucerization:
curettage of cavities to promote new bone formation.
It is special type of chronic osteomylitis. -salmonella osteomylitis in S.C.A &
It's occur when resistance of patient is high and typhoid osteomylitis.
the micro-organism with low virulence. -Fungus osteomylitis in madura foot
It is localized infection within bone. (Actinomycosis)
Boride's abscess C.P:
no systemic signs.
localized deep pain.
X-ray:
localized oval cavity (translucent) surrounded
by sclerotic bone, in the metaphysis.
Treatment:
saucerization.
