Osteomyelitis

Prof Abbas Bajwa

Head of Orthopedics Department,
Sharif Medical & Dental College, Lahore

Osteomyelitis
Osteomyelitis is defined as a suppurative
infection of the bone caused by pyogenic
organisms.
Classified as
Acute = < 2 weeks duration
Subacute = 2-3 weeks duration
Chronic = > 3 weeks duration

Osteomyelitis

Routes of spread

Hematogenous spread is most common

Extension from a contiguous site
Direct (trauma)

Common organisms include

Staph aureus - acute hematogenous osteomyelitis
Group B streptococcus Neonates
H. Influenza children 6 months to 4 years
Pseudomonas IV drug abuse, puncture wounds,
genitourinary infections
Salmonella Sickle cell disease

Factors predisposing to bone

infection

Malnutrition and general debility

Diabetes mellitus
Steroids administration
Immune deficiency
Immunosuppressive drugs
Venous stasis in limb
Peripheral vascular disease
Loss of sensibility
Iatrogenic invasive measures
trauma

Pathophysiology
Organism localized in bone

Bacteria proliferate and induce inflammatory reaction &

cause cell death
Bone undergoes necrosis within first 48 hours
Bacteria and inflammation spread within the shaft of the
bone and may percolate throughout the haversian systems
and reach the periosteum
Subperiosteal abscess
Segmental bone necrosis sequestrum (dead piece of bone)
Rupture of periosteum leads to an abscess in the surrounding
soft tissue and the formation of draining sinus.

Pathophysiology

Over time, host response develops

After first week of infection chronic
inflammatory cells become more numerous
Cytokines from leukocytes stimulates
osteoclastic bone resorption ingrowth of
fibrous tissue deposition of reactive bone
in the periphery
Reactive woven or lamellar bone which
forms sleeve of living tissue surrounding
dead bone is called as involucrum.

Brodie abscess: is a small

intraosseous abscess that frequently
involves the cortex and is walled off
by reactive bone

Sclerosing osteomyelitis of
Garre: typically develops in jaw and
is associated with extensive new
bone formation

Osteomyelitis
gross & microscopy

Sequestrum (necrotic bone)

Involucrum (new bone)

Osteomyelitis of the
tibia of a young child.
Numerous abscesses
in the bone show as
radiolucency.

Clinical Presentation
-Severe pain, malaise, fever,
refusal to bear weight

toxemia and

-Recent history of infection a septic toe, a

boil, a sore throat or discharge from ear
-Local redness, swelling, warmth and edema &
tenderness
- In case of chronic OM
Multiple discharging sinuses
Induration of surrounding skin
Muscular wasting

DIAGNOSIS & WORK UP

Plain x-rays displacement of fat planes,
periosteal new bone formation, sequestrum,
regional osteoporosis
USG for Subperiosteal fluid collection
Radionucleotide Scan highly sensitive but
less specific
M.R.I in doubtful cases, for bone marrow
edema.

Laboratory investigations
Hemoglobin - low
TLC - high
ESR high (24-48 hrs)
CRP high (12-24 hrs)
ASO titers +ve

Differential Diagnosis
of
OSTEOMYELITIS

1.
2.
3.
4.
5.
6.

Cellulitis
Acute suppurative arthritis
Streptococcal necrotizing myositis
Acute rheumatism
Sickle cell crisis
Gauchers disease

Principles of treatment for

Osteomyelitis
Analgesia and fluids
Rest to the affected part
Identify organism and give effective
antibiotics
Release pus as soon as it is formed
Stabilize the bone if it has fractured
Eradicate avascular or necrotic bone

Restore

continuity if there is gap in

the bone

COMPLICATIONS OF
OSTEOMYELITIS
1)
2)
3)
4)
5)
6)
7)

Epiphyseal damage
Altered bone growth
Suppurative arthritis
Metastatic infection
Pathological fractures
Chronic osteomyelitis
Squamous cell carcinoma of
the skin

Thank you !!