OSTEOMYELITIS Flashcards
A severe infection of the
bone, bone marrow and
surrounding soft tissue.
Osteomyelitis
3 classifications of Osteomyelitis
❑Hematogenous osteomyelitis
❑Contiguous-focus osteomyelitis
❑Osteomyelitis with vascular insufficiency,
due to bloodborne spread of infection
❑Hematogenous osteomyelitis
from contamination from bone surgery, open fracture or traumatic injury (e.g., gunshot wound)
❑Contiguous-focus osteomyelitis
seen most
commonly among patients with diabetes and
peripheral vascular disease, most commonly
affecting the feet.
❑Osteomyelitis with vascular insufficiency,
Acute
Less than 2 wks
Early acute
Late acute 4-5 days
Sub acute
2-6 wks
Less virulent - more immune
Chronic
> 6 weeks
Type of osteomyelitis commonly
seen in children, with 85% of affected individuals usually under the age of 1.
❑Acute hematogenous osteomyelitis
Bacteria that causes more than 50% of bone
infections
❑Staphylococcus aureus
❑Gram-positive organisms
streptococci and
enterococci
❑Gram-negative bacteria
pseudomonas
Extension of soft tissue
infection (eg, infected
pressure or vascular ulcer,
incisional infection)
INDIRECT
bloodborne)
spread from other sites of
infection (eg, infected tonsils,
infected teeth, upper
respiratory infections)
Hematogenous
Direct bone
contamination from bone
surgery, open fracture,
prosthesis or traumatic
injury (eg, RTA )
DIRECT
FACTORS AFFECTING THE
EXTENT OF INFECTION (VUIT)
Virulence of the infecting organism,
Underlying disease
Immune status of the host,
The type, location, and vascularity of the
bone
dead bone tissue which does not easily liquefy and drain
sequestrum
New bone growth that forms and
surrounds the sequestrum.
involucrum
The opening in the involucrum through which pus & sequestra make their way out.
Cloaca
When bone infection persists for months, the
resulting infection is referred to as
chronic osteomyelitis
fever, night sweats, chills, restlessness, nausea and malaise
SYSTEMIC
constant bone pain, swelling, tenderness and
warmth at the site of infection, drainage from site and restricted movement of affected part
LOCAL
This should be postponed if
the patient has a current infection (e.g. urinary tract infection, sore throat).
❑Elective orthopaedic surgery
This is administered to achieve
adequate tissue levels at the time of surgery and for 24 hours after surgery, thus are helpful.
❑Prophylactic antibiotics
This reduces the incidence of superficial infections and osteomyelitis.
❑Aseptic postoperative wound care
This reduces extension of infection to the bone or hematogenous spread.
❑Prompt management of soft tissue infections
Warm wet soaks for ________ several
times a day may be prescribed to increase
circulation
20 minutes
Commonly used antibiotics
Clindamycin
Linezolid
Rifampin
❑Because there is decreased penetration by
medications, antibiotic therapy is longer term
than with other infections; typically it
continues for _____ after the infection appears to be controlled, the antibiotic may be administered orally up to _____
3-6 wks, 3 months
removal of enough involucrum
to enable the surgeon to remove the sequestrum
sequestrectomy
sufficient bone is removed to
convert a deep cavity into a shallow saucer.
❑Saucerization
used to
remove debris
closed suction irrigation system
COMPLICATIONS
❑Septicaemia
❑Septic arthritis
❑Pathologic fractures
❑Amyloidosis
