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Acute Osteomyelitis Chronic Osteomyelitis Infection in the bone – inflammation of bone caused by a pyogenic organism Hematogenously seeded – usual

path Other paths: local invasion from a contiguous infection Direct inoculation from penetrating trauma Secondary to an open injury to bone and surrounding soft tissue Approximately 50% of cases occur in preschool-aged children. Young children primarily experience acute hematogenous osteomyelitis due to the rich vascular supply in their growing bones. Circulating organisms tend to start the infection in the metaphyseal ends of the long bones because of the sluggish circulation in the metaphyseal capillary loops. The presence of vascular connections between the metaphysis and the epiphysis make infants particularly prone to arthritis of the adjacent joint. Involvement of the shoulder joint or hip joint is also noted when the intracapsular metaphyseal end of the humerus or femoral is infected. If untreated, infection can also spread to the subperiosteal space after traversing the cortex. Femur> tibia>fibula = most common [lower limbs are more common] Humerus> radius > ulna S. Aureus S. Aureus, S. Epidermidis, Pseudomonas Within 2 weeks > 1 month Waldvogel Classification System for Osteomyelitis Hematogenous osteomyelitis Osteomyelitis secondary to contiguous focus of infection No generalized vascular disease Generalized vascular disease Chronic osteomyelitis (necrotic bone) Predominantly in children Usually occur in adults Metaphysis of long bones – most common Usually secondary to open wound, most Present within several days to one week often an open injury to bone and after onset of symptoms surrounding soft tissue Tenderness over the involved bone Localized bone pain, erythema and drainage Decreased ROM in adjacent bone around the affected area Cardinal signs: draining sinus tracts, deformity, instability and local signs of impaired vascularity, ROM and neurologic status Sudden onset of s/sx Not ill looking Pus under the periosteum -> pain > 1 month Ill-looking sequestrium: necrotic History of non-musculoskeletal infection – involucrum: new bone sinusitis, pharyngitis, otitis media (+) joint effusion Leukocytosis in 50% Increased ESR and CRP Blood cultures are positive in 50% of

Brodie’s abscess Gold standard: histopathologic and microbiologic examination of bone is the gold standard for diagnosing osteomyelitis Cultures of sinus tract samples are not reliable for identifying causative organisms Children (1-26 years old) S.periosteal reaction and sequestra A bone abscess found during the subacute or chronic stage of hematogenous . influenzae Antibiotic Therapy 4 to 6 weeks of appropriate antibiotic therapy empiric treatment: nafcillin + cefotaxime/ceftriaxone 2 weeks of IV then oral agent Chronic OM in adults – antibiotics and surgical debridement IV for 2-6 weeks Oral: fluoroquinolones .children Radiographic evidence may not appear until 2 weeks after onset of infection .osteolysis . aureus Strep pyogenes H.