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Acute Osteomyelitis - Coggle Diagram

- - - - advantage
        
        soft tissue swelling
        
        periosteal reaction
        
        haziness
        
        osteolysis
        
        bone losses its mineral content
        
        cheap and can detect sequestra
      - disadvantage
        
        Normal at initial stage
        
        less suitable for exact location
    - - advantage
        
        useful in assesing progression of union
        
        csmall sequestra
        
        extent of bone and soft tissue involvement
      - disadvantage
        
        many artefact
    - - indication
        
        For the evaluation of surrounding soft tissues and bone marrow
      - most accuaret technique
      - Advantage
        
        bone marrow with the surrounding soft tissues
        
        deciding the extent of the surgical debridement
      - Disadvantage
        
        pacmaker ga bisa
        
        malignancy, Langerhans cell histiocytosis (LCH), neuropathic
        arthropathy, reactive osteitis, osteoid osteoma, and stress fractures susah untuk dibedakan
    - - Phase
        
        first phase (perfusion phase or flow study) is performed dynamically
        for the first 2 minutes
        
        second phase (blood
        pool phase) is performed directly after the first phase (2 to 5 minutes after injection)
        
        third phase (static phase) is performed 3 hours after the injection and depicts the
        incorporation of the 99mTc into the matrix of the bone
      - Cara Kerja
        
        depicting osteoblast activity
  - - - Can be normal jg
  - - - should be taken from deep representative tissues and bone
      - At least three samples should be obtained
      - Conventional blood cultures are only useful in case of hematogenous
        osteomyelitis
- - - - Removal of all the devitalized tissue and pathogens and elimination of the inflammatory process
      - Dead space management
      - Stimulation of bone repair (if healing has not occurred)
      - Restoration of the mechanical axis of the limb and previous functional capacity
      - Reduction of the risk of recurrence
  - - - Duration 4-6 weekz
  - - - Beta-lactams antibiotics
        
        Polymixins
        
        Aminoglycosides, chloramphenicol,tetracyclines, macrolides, lincosamides,streptogramins
        
        Rifamycins, fluoroquinolones,metronidazole, macrolides
        
        Sulfonamides, diaminopyrimidines
    - - PMMA bone cement
        
        function
        
        as a spacer or as strings of beads aiding in management of dead space
    - - Function
        
        fill the dead space after surgical debridement
      - types
        
        calckium culfate sebagai pengganti autologous bone graft
        
        hydroxiappatite
  - - - Advantg
        
        reduction of bacteriL LOAD
      - disad
        
        lead to creation of dead space
    - - advantage
        
        Debridement of the medullary canal
      - disadvatage
        
        can lead to thermal cortical necrosis
    - - patient should be fit
      - removing all the devitalized, dead, and infected bone, as well as the necrotic and hypoxic surrounding soft tissues
      - 3 litres of saline after debridement
      - wound closure is not essential , pertimbangkan vacuum dressing
      - if metalwork present
        
        consider removal of implant
        
        ga bisa dilakukan jika fraktur tidak sembuh atau infected nonunion
        
        jika diambil, external fixation can be used
      - if intramed is involved
        
        intramedullary reaming of the canal
    - - Critical size bone defect
        
        Masquele
        
        Implantation of PMMA spacer
        
        Ilizarov bone transport
      - Soft tissue defect
        
        can need free flap
    - - why important
        
        If not covered or filled with wellvascularized tissue, this can lead to collections or abscesses
      - choice of treatment
        
        principel
        
        characteristics of the lesion
        
        physiologic grading of the host
        
        Primary bone grafting
        
        not associated with good success rates because of resorption of the bone graft
        
        because of inflammation
        
        Antibiotic impregnanted cement spacer
        
        Indication
        
        infection eradicated first
        
        Locap flap
        
        Promote healing
    - - malignant transformation of chronic osteomyelitis
      - multiple unsuccessful surgical debridements or reconstructive procedures
- - - - presenting 2 weeks after bone infection
  - - - 6 weeks after bone infection
    - - Cierny mader
        
        Anatomic
        
        I Medullary osteomyelitis
        
        II Superficial osteomyelitis
        
        III Localized osteomyelitis
        
        IV Diffuse osteomyelitis
        
        Physiologic
  - - - through systemic curculation
      - contohnya vertebral body, pyogenic spine
    - - direct inoculation of pathogen to bone
        
        contiohnya sprti open fracture, joint replacement
    - - karena diabetes
- - - - pada chronic stage, inflammatory cells release cytokine
        
        increased osteoclastic activity
        
        reactive new bone
        
        involucrum
        
        sleeve of living
        tissue formed by the newly deposited bone around the infected, devitalized bone
    - - can lead to tissue necrosis and bone destruction
  - - - can be in orthopaedic implant
    - - (S. aureus and S. epidermidis),Pseudomonas
        aeruginosa, and Propionibacterium acnes
    - - Biofilm adheres to bone first
      - these bacteria secrete protein matrix
      - Make quorum
  - - - infected non union
- - - - infection of the deep dermis and subcutaneous tissue
    - - inoculation of pathogens inside the
        joint
    - - involving the incision or organ or space, occurring after surgery
    - - infection that involves a joint prosthesis and its adjacent tissues
    - - posttraumatic osteomyelitis, osteitis, or
        deep infection, is a common but devastating complication following trauma