Infections of the bone

Dr. Mehzabin Ahmed

 Osteomyelitis

It is the infection of the bone.

Osteomyelitis is the most common infection, followed by
septic arthritis, and then bursitis, parasitic cysts in the
muscles, and abscesses in the decreasing order of
frequency.
Types
 Osteomyelitis can be either acute or chronic based
on the duration of the disease.
Etiopathogenesis

Bacteria are the most common cause of osteomyelitis,

though fungi also can cause osteomyelitis.

The organisms commonly implicated are

Staphylococcus aureus,
Staph. epidermidis,
Gram-negative bacteria,
Anaerobic bacteria etc.
Spread
 The bacteria reach the bone by the
hematogenous route or by direct spread
from a focus of infection on the skin or
overlying soft tissue or in case of
compound fractures (open fractures
associated with injuries to the overlying
skin & soft tissue).
Sites
 Metaphysis of the long
bones are the most
common sites to be
involved.
 This predilection is
seen because the
branches of the
nutrient artery (artery
supplying the bone)
arch below the growth
plate and terminate
into venous sinusoids,
thus slowing down
the blood flow.
 These venous
sinusoids provide an
ideal pool of blood for
the bacterial seeding
and proliferation
Morphology
 As the infection progresses
 the inflammatory exudates that fills the medullary cavity
spreads into
 the Haversian canals and compresses the blood vessels
 resulting in ischemia and necrosis of the overlying cortical
bone.
 This necrotic dead bone is called the sequestrum.
 The osteoblasts lay down new bone just below the periosteum
 This is known as the involucrum.
 The involucrum has holes called cloacae, in order to allow the
pus to drain through from the bone into the surrounding soft
tissue
 When the purulent exudate reaches the periosteum, it lifts it
and collects beneath it, thus forming a subperiosteal abscess.
 If the condition is left untreated then the pus tracks out into
the surrounding soft tissue and form sinus tracts that drain the
pus to the surface.
Complications
If not treated promptly it results in chronic osteomyelitis,
which may be complicated by:
• Septicaemia: due to invasion of the blood by the
organisms
• Septic embolism resulting in abscess in the kidneys,
lungs, heart, etc.
• Destruction of the growth plate resulting in the limb
length discrepancy especially in children.
• Amyloidosis may develop in long standing cases
• Secondary malignancies like sarcomas (rare) and
Squamous cell carcinoma of the sinus tract may also
develop.
•Pott’s spine- seen in Tuberculous infections of
the vertebrae
•It is usually seen in the thoracic, lumbar and
cervical vertebrae.
•Tubercular granulomas form in the vertebral
bodies, and the intervertebral discs are also
involved early in the disease.
•This causes them to collapse resulting in
kyphosis, the forward acute angulation of the
spine is known as Gibbus.
•The infection may also track down in between
the parvertebral muscles to form abscess (eg,
Psoas abscess).
•The spinal cord may be compressed, due to
the formation of extradural abscess or due to
the sequestrum, resulting in paraplegia
(paralysis of the lower limbs)
Brodie’s abscess Some times a

thick layer of reactive bone walls

off the infection to form a focus

of chronic low-grade infection.

Madura foot- caused by fungus and fungus like
(Actinomycetes) infection.

Salmonella osteomyelitis- in patients with sickle cell

anemia.

Periostitis- in syphilis

Leprosy- trophic ulcers and underlying osteomyelitis.

Diabetes mellitus- predisposes to infection especially

formation of deep ulcers with osteomyelitis of the
underlying bone
Infections following surgeries- like in implants, joint
replacements and amputated stumps

Other complications of amputations

Besides infection the following complications may be seen:
 Hematoma formation
 Skin flap necrosis
 Joint deformities
 Neuromas of the ends of the cut nerves
 Phantom limb pain sensation
 At the end of the lesson on Osteomyelitis , the student
should be able to:
 Define osteomyelitis, sequestrum, involucrum.
 Enumerate the routes by which the infections reach the
bone.
 Enumerate the complications of osteomyelitis.
 List the sites commonly involved by Pott’s disease.
 Explain briefly the development of kyphosis in Pott’s
disease.