Osteomyelitis.ppt

7/24/2019 Osteomyelitis.ppt

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Bone pathologyBone pathology

22ndndyr undergraduateyr undergraduate

presentationpresentation


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TopicsTopicsOsteomyelitisOsteomyelitis

Fracture healingFracture healing


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OsteomyelitisOsteomyelitis

Infammation o bone and marrowInfammation o bone and marrow ClassicationClassication

1)1)The duration acute! subacute andThe duration acute! subacute and

chronicchronic2)2)"echanism o inection #"echanism o inection #

e$ogenous or haematogenouse$ogenous or haematogenous

%)%)The type o host response to theThe type o host response to theinection pyogenic or non pyogenicinection pyogenic or non pyogenic


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EpidemiologyEpidemiology

"ost common type o bone"ost common type o bone

inection! usually seen in childreninection! usually seen in children

&ecrease in incidence! could be&ecrease in incidence! could bedue to higher standard o li'ing anddue to higher standard o li'ing and

impro'ed hygiene(impro'ed hygiene(

imodal distribution younger thanimodal distribution younger than2 years! and *12 years2 years! and *12 years

"ore common in males"ore common in males


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Routes of spreadRoutes of spread

Hematogenous spread:Hematogenous spread:most commonmost commoncause+ usually long tubular bones ocause+ usually long tubular bones ochildren+ usually metaphyseal in childrenchildren+ usually metaphyseal in children

and adults! although in'ol'ement o fatand adults! although in'ol'ement o fatbones is more common in adultsbones is more common in adultsDirect extension:Direct extension:less common! may beless common! may be

associated with trauma or rarelyassociated with trauma or rarely

iatrogenic implantation o inectiousiatrogenic implantation o inectiousmaterialmaterial

&"! immunodeciency! I, &rug abuse (&"! immunodeciency! I, &rug abuse (


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Pyogenic osteomyelitisPyogenic osteomyelitis

-cute osteomyelitis usually occurs in children-cute osteomyelitis usually occurs in children .sually a haematogenous inection rom.sually a haematogenous inection rom

distant ocusdistant ocus Organisms responsible include/Organisms responsible include/

Staph. aureusStaph. aureus Strep. pyogenesStrep. pyogenes H. infuenzaeH. infuenzae 0ramnegati'e organisms0ramnegati'e organisms

almonella inections are oten seen in thosealmonella inections are oten seen in thosewith siclecell anaemiawith siclecell anaemia Inection usually occurs in metaphysis o longInection usually occurs in metaphysis o long

bonesbones


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BacteriaBacteria

taphylococcus aureus in *34 totaphylococcus aureus in *34 to534 o cases534 o cases

6(coli! 7seudomonas! and 8lebsiella6(coli! 7seudomonas! and 8lebsiella

in patients with genitourinary tractin patients with genitourinary tractinections and I, drug abusers(inections and I, drug abusers(

In neonates/ 9emophilus infuen:aIn neonates/ 9emophilus infuen:a

and group streptococciand group streptococci In patients with sicle cell disease #In patients with sicle cell disease #almonella inectionalmonella inection


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Organisms once locali:ed in boneOrganisms once locali:ed in bone

acteria prolierate and induce infammatory reaction andacteria prolierate and induce infammatory reaction andcause cell death(cause cell death(

one undergoes necrosis within rst ;* hoursone undergoes necrosis within rst ;* hours

acteria and infammation spread within the shat o theacteria and infammation spread within the shat o thebone and may percolate throughout the ha'ersianbone and may percolate throughout the ha'ersian

systems and reach the periosteumsystems and reach the periosteumubperiosteal abscessubperiosteal abscess

egmental bone necrosisegmental bone necrosissequestrum (dead piecesequestrum (dead piece

of bone)of bone)


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linical featureslinical features

Child usually presents with pain! malaiseChild usually presents with pain! malaiseand e'erand e'er Oten unable to weight bearOten unable to weight bear 6arly signs o infammation are oten ew6arly signs o infammation are oten ew

one is oten e$=uisitely tender withone is oten e$=uisitely tender withreduced ?oint mo'ementreduced ?oint mo'ement

@ate inection presents with sottissue@ate inection presents with sottissueswellings or discharging sinusswellings or discharging sinus

&iagnosis can be conrmed by aspiration&iagnosis can be conrmed by aspirationo pus rom abscess or metaphysiso pus rom abscess or metaphysis A34 o patients ha'e positi'e bloodA34 o patients ha'e positi'e blood

culturescultures


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RadiologyRadiology

Brays can be normal during rstBrays can be normal during rst% to A days% to A days

In the second wee radiologicalIn the second wee radiologicalsigns include/signs include/ 7eriosteal new bone ormation7eriosteal new bone ormation 7atchy rareaction o metaphysis7atchy rareaction o metaphysis"etaphyseal bone destruction"etaphyseal bone destruction


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#equestrum (necrotic#equestrum (necrotic

bone)bone)


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hronic Osteomyelitishronic Osteomyelitis

on specicon specic

&e'elops in 1A%34&e'elops in 1A%34

&ue to lac o treatment! inade=uate&ue to lac o treatment! inade=uateantibiotic treatment or incompleteantibiotic treatment or incomplete

surgical debridement o necrotic bonesurgical debridement o necrotic bone

pecicpecic

T osteomyelitisT osteomyelitis

yphilitic osteomyeltisyphilitic osteomyeltis


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Spinal tuberculosis. Magnetic resonance imaging of the spinerevealing osteomyelitis involving T10 and T11 vertebral bodies

and disc space (A; arrow and an ad!acent multiloculated

paravertebral abscess ("; arrow.


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#yphylitic Osteomyelitis#yphylitic Osteomyelitis

ected are those o nose! palate!

sull and e$tremities! especially the long tubularsull and e$tremities! especially the long tubular

bones such as tibia(bones such as tibia( 9istology / edematous granulation tissue9istology / edematous granulation tissue

containing numerous plasma cells and necroticcontaining numerous plasma cells and necroticbone(bone(


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#abre tibia#abre tibia


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Reactive phaseReactive phase


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Reactive phaseReactive phase


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Reparative phaseReparative phase


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Remodeling phaseRemodeling phase

0etting bac original shape o the0etting bac original shape o the

bone (bone (

"ainly done by osteoclastic"ainly done by osteoclastic

acti'ation(acti'ation(


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Osteomyelitis.ppt

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