OSTEOMYELITIS Infection of the bone, most commonly caused by Staphylococcus Aureus. It can be either acute or chronic.

OTHER NAME Hematogenous Osteomyelitis TYPES There are three main types of osteomyelitis: Acute osteomyelitis - bone infection develops within two weeks of an initial infection, injury or the onset of an underlying disease. • Sub-acute osteomyelitis - bone infection develops within one or two months of an initial infection, injury or onset of an underlying disease. • Chronic osteomyelitis - bone infection develops two months or more after an initial infection, injury or onset of an underlying disease.

CAUSES Bone infection can be caused by bacteria (more common) or fungi (less common). • • • Infection may spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore). The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood. A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone. STAGES OF OSTEOMYELITIS

feet.RISK FACTORS • • • • • • Trauma Diabetes Injected drug use Hemodialysis Old age .↓Immune function Poor circulation SIGNS AND SYMPTOMS • • • • • Pain and/or tenderness in the infected area Swelling and warmth over the infected area Fever General discomfort. yielding a limp) PATHOPHYSIOLOGY Predisposing factors: • vascular insufficiency disorders • genitourinary infections • respiratory infections • IV drug use • Immune-compromising diseases • history of blood.stream Open wounds/fractures Microorganisms lodge into an area where circulation slows Microorganisms grow . or ill feeling Drainage of pus through the skin Additional symptoms that may be associated with this disease include: • • • • • Excessive sweating Chills Lower back pain (if the spine is involved) Swelling of the ankles. uneasiness. and legs Changes in gait (walking pattern that is a painful.

Increase pressure Ischemia Vascular compromise Infection through the bone cortex and Ischemia of the periosteum Cortical devascularization Necrosis Formation of new bone Sequestr Separation of devitalized bone from living bone Continues to be an infected island Involucrum Difficulty to reach by blood borne antibiotics Chronic Stage Enlarged sequestrum Development of sinus tract Turns to scar tissue Site for continued microorganism growth Sequestrum move out to the soft tissue Revascularize d Removal by the normal immune process Healing Remission and exacerbation .

If there are metal plates near the infection. • • • Incision and Drainage of bone abscess. • • • • Antibiotics as prescribes. ESR (erythrocyte sedimentation rate) .administered to achieve adequate tissue levels at the time of surgery and for 24 hours after surgery. sore throat) or a recent history of infection. Sequestrectomy. During orthopedic surgery. Maintain proper body alignment and change position frequently to prevent deformities.use sterile technique. they may need to be removed. careful attention is paid to the surgical environment and to techniques to decrease direct bone contamination. Bone lesion biopsy or culture (may reveal the causative organism).WBC may be elevated (indicates presence of active infection).may be elevated (indicates inflammatory process). Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. • Analgesics as prescribed. Immobilization of the affected part. Bone Scan (indicates infected bone). Needle aspiration of the area around affected bones MRI of the bone TREATMENT AND MANAGEMENT The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues. Dressing changes . PREVENTION • Elective orthopedic surgery should be postponed if the patient has a current infection (like urinary tract infection.Excessive vascular DIAGNOSTIC EXAM insufficiency • • • • • • Loss of organ function Amputation CBC. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue. Prophylactic antibiotics. infected bone and cartilage. Bone grafting is recommended after repeated infections. • • .removal of dead.

http://www. 2064-2067 2. Aseptic postoperative wound care reduces the incidence of superficial infections and osteomyelitis.htm ILLUSTRATION .wrongdiagnosis. http://www. When patients who had joint replacement surgery undergo dental procedures or other invasive procedure. 2005 3.• • • Urinary catheters and drains are removed as soon as possible to decrease the incidence of hematogenous spread of infection.gov/medlineplus/ency/article/000437. Professional Guide to Diseases (Eighth Edition).nlm. prophylactic antibiotic are frequently recommended. COMPLICATION • • • • • • • Necrosis Blood clots Sequestra (A piece of necrotic tissue. which has become separated from the surrounding healthy tissue). Bone abscess Need for amputation Reduced limb or joint function Spread of infection to surrounding tissues or the bloodstream REFERENCES: 1.nih.com/o/osteomyelitis/intro. usually bone.htm 4. Brunner and Suddarth’s Textbook of Medical Surgical Nursing pp.