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 Staph.

aureus,

epidermidis, bacteria, etc.

Gram-negative

Anaerobic bacteria

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.

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