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OSTEOMYELITIS

General aspect of infection • Acute pyogenic infection

• Chronic infection

• ACUTE PYOGENIC INFECTION
• Formation pus • Spread  • via lymphatics lymphangitis , lymphadenopathy •  blood stream (bacteraemia,septicaemia) • Systemic reaction  lassitude, mild pirexia, severe illness, fever, toxemia,shock

• CHRONIC INFECTION
• • • • • • •

Follow on acute Depending on type micro orgnisme,host reaction Granulation tissuefibrosis Somea non-pyogenic rxcellular granuloma ( lymphocytes, modified macrophages, multinucleated giant cells (Typically TB)

• Host response…
• Very young –very old • States malnutrition • Immuno-suppression

• Local response… • Damage muscle • Foreign material • Bone rapidly controled

• Principless of treatment… • • • • • •

Provide analgesia+supportive Rest Antibiotic effective Surgical eradication( infected+necrotic tissue) Acute: time is improtant Chronic: choose surgical ,conservative

Inflamation
• Vascular congestion • Exudation of fluid • Infiltration by pmn leucocytes ☼ intraosseous pressure  pain ☼ obstrucion blood flow+intravasc thromb  ischaemia

Suppuration
• • • • • • 2-3 day Pus within boneway the volkman canals Surfacea subperiosteal abscess Spread  the shaft  enter another level  sorrounding soft tissue

• In Infant: • ◙The physis ephysis joint • Older child: • ◙The physis  barier • ◙Metaphysis partly intracapsular • pus through periosteum->joint • In adult : • ◙Abcess spread in medullary cavity • ◙Vertebraat end plate + intervertebra disc • vertbra body

Necrosis
• • • • Rising intraosseous pressure Vascular stasis Infective thrombosis Periosteal stripping
Compromise •• Compromise • Blood supply • Blood supply

•  bone is death + bacteria toxin + leucocytes enzym  advances tissue destruction • Infant : • Growth disc irreparable damage • The epiphysis  AVN

Acute haematogenous osteomyelitis

Acute haematogenous osteomyelitis

Clinical features
• • • • • • • Usually child : • Compromise Severe pain • Blood supply Malaise Fever Toxemia (neglected cases) The limb is held still ( above/below knee, fossa poplitea,groin)

Clinical features

• Compromise • Blood supply

Clinical features…
• • • • • • In adult : Thoracolumbar spine( commonest) History urologic procedure( fever,backache) Local tenderness( before x-ray) Need confirm (FNA and bacterologic culture) Other bone  involve

Clinical features..
• Acute osteomyelitis • • • • Pain Fever inflamation Acute tenderness

Unless modified By antibiotics

• X-ray normal during first 10 days

Diagnostic imaging
• • • • • • • Appears at few days ( 10 days) - soft tissue swelling -xtra-cortical outline periost new bone form ( classic x-ray sign of pyogenic osteomyelitis) TREATMENT DON’T DELAYED Later periosteal thickening more obvious Features bone destruction

I DRESSED , CARED THE WOUND , GOD HEALED IT
AMBROISE PARE’ FRENCH SURGEON 16 TH CENTURY