Please enable JavaScript.
Coggle requires JavaScript to display documents.
Osteomyelitis (Diagnosis (Imaging (X-rays (abnormal after 2 to 4 week,…
Osteomyelitis
Diagnosis
-
Lab
- WBC may be elevated, but it frequently is normal.
- A leftward shift is common
- C-reactive protein level is elevated
- erythrocyte sedimentation rate usually is elevated (90%)
- Aspiration: samples of the infected site are normal in 25% of cases.
- Blood culture: positive in only 50% of patients with hematogenous osteomyelitis
Imaging
X-rays
- abnormal after 2 to 4 week, showing:
1.periosteal elevation,
2.bone destruction,
3.soft-tissue swelling,
4.in the vertebrae, loss of vertebral body height
Ultrasonography
- May demonstrate changes as early as 1-2 days afteronset of symptoms.
- Abnormalities include soft tissue abscess or fluid collection and periosteal elevation.
- Allows for ultrasound-guided aspiration.
CT
- abnormal calcification, ossification, and intracortical abnormalities.
MRI
- effective in the early detection and surgical localization of osteomyelitis.
- requires 2 of the 4 following criteria:
-Purulent material on aspiration of affected bone
-Positive findings of bone tissue or blood culture
-Localized classic physical findings of bony tenderness, with overlying soft-tissue erythema or edema
-Positive radiological imaging study
Symptoms and Signs
acute osteomyelitis
- weight loss, fatigue, fever, and localized warmth, swelling, erythema, tenderness.
Vertebral osteomyelitis
- localized back pain, tenderness withparavertebral muscle spasm that is unresponsive to conservative treatment, Patients are usually afebrile.
Chronic osteomyelitis
- intermittent (months to many years) bone pain, tenderness, draining sinuses, nonhealing ulcer
-
Treatment
Antibiotics
- selected to cover both gram- positive and gram-negative organisms until culture results and sensitivities are available.
- In children and adults, initial antibiotic treatment should include a penicillinase-resistant semisynthetic penicillin (nafcillin or ciprofloxacin )
- Treatment is required for at least 6 to 8 weeks
- Antibiotics must be given parenterally for 2 to 4 weeks
-
Prevention
- Acute hematogenous osteomyelitis can be avoided by preventing bacterial seeding of bone from a remote site. This involves the appropriate diagnosis and treatment of primary bacterial infections.
- Direct inoculation osteomyelitis can best be prevented with appropriate wound management and consideration of prophylactic antibiotic use at the time of injury.
Complications
Bone abscess, Bacteremia, Fracture, Loosening of the prosthetic implant, Overlying soft-tissue cellulitis, Draining soft-tissue sinus tracts
- an acute or chronic inflammation of the bone and its structures secondary to infection with pyogenic organisms.
- more in male
- mechanism of spread: hematogenous (most common) vs. direct-inoculation vs. contiguousfocus
- Acute hematogenous osteomyelitis is primarily a disease in children.
- Direct trauma and contiguous focus osteomyelitis are more common among adults and adolescents
- Spinal osteomyelitis is more common in persons older than 45 years.
- Morbidity can include spread of infection to:
-associated soft tissues or joints;
-evolution to chronic infection, with pain and disability;
-amputation of the involved extremity;
-generalized infection
-sepsis
- The infection associated with osteomyelitis may be localized or it may spread through the periosteum, cortex, marrow, and cancellous tissue.