Osteomyelitis

Definition Osteomyelitis
Osteomyelitis is an infection of the bone and bone medulla
well as non-pyogenic or pyogenic infections, for example
mikobacterium tuberculosa. It can remain localized or can
spread through bone marrow involves the cortex, kanselosa
tissue, and periosteum. It can be acute or chronic
 etiology

Basically, all types of organisms, including viruses,

parasites, fungi, and bacteria, can cause osteomyelitis,
but is most often caused by certain pyogenic bacteria
and mycobacteria
patogenesis
 patogenesis

Caption:

1. Focus on the hole infection will develop and at this stage raises
periosteal edema and swelling of the soft tissues.
2. Focus then growing form of inflammatory exudate network that
ensued subperiosteal abscess and cellulitis under the soft tissue
3. Furthermore, the area above the periosteum elevation occurs
lesions, infections and Abscesses periosteum penetrate the soft
tissues where the abscess can flow out through the sinuses to
the skin surface. Will lead to the formation of bone necrosis and
infection sekuestrum will continue into the medullary cavity.
 RISK FACTOR

 Diabetes mellitus
 Patients receiving hemodialysis
 People with poor immune systems / bad
 Sickel cell disease
 Intravenous drug abuse
 Age, especially regarding baby and children
 Alkoholisme
 Long-term steroid use
 Chronic joint disease
 Trauma (orthopedic surgery or open fracture
 The use of prosthetic orthopedic
 classification

Osteomyelitis can generally be classified based on the

clinical course, osteomyelitis acute, subacute, and
chronic. It depends on the intensity of the infection and
symptoms related.
 clinical symptoms

a. Clinical symptoms of acute osteomyelitis

 In early disease, systemic symptoms such as febrile,
anorexia, and malaise prominent, while the local
symptoms such as swelling or cellulitis not appear.
 In newborns, infants looked nervous, and irritable. Usually
more common in infants with 'high risk' as premature,
underweight babies history of difficult labor or umbilical
artery catheters
 In adults, the most common place is on the predilection
thorakolumbal vertebra. Can only attack patients with a
history of problems in the urinary tract
b. Clinical symptoms of subacute osteomyelitis
 Haematogenous Subacute osteomyelitis usually found in
children and adolescents. Clinical features that can be found is
muscle atrophy, local pain, a little swelling, and can also be
crippled sufferer. Feel pain in the area around the joint for a few
weeks or months. The patient's body temperature is usually
normal.
c. Clinical symptoms of choronic osteomyelitis
Localized bone pain, redness, and drainage around the affected
area often arise. On physical examination findings sinus, fistula or
cicatricial scar with tenderness, deformity, instability, and signs of
the disorder vascularization, range of motion, and neurological
status. May be found protruding sekuestrum
 diagnosis

 radiography
In osteomyelitis of the extremities, photo plain radiographs and bone
scintigrafi is the primary screening tool. Radiographic evidence of osteomyelitis
will not appear until approximately two weeks after the onset of infection
 Scintigrafi bone
For imaging nuclir, Technetium Tc-99m methylene difosfonat is the main agent
of choice. The sensitivity of this examination is limited to the first week and not
at all specific
 MRI (Magnetic resonance imaging)
Magnetic resonance imaging (MRI) is helpful in detecting osteomyelitis. MRI is
superior when compared to radiography, CT scans and bone scintigrafi MRI had
a sensitivity of 90-100% in the detection of osteomyelitis
 Ultrasonografi dan CT (computed tomographic) scan
Ultrasonography and CT (computed tomographic) scan
can help diagnose osteomyelitis. Ultrasound can show
the changes as early as 1-2 days after onset of
symptoms. Ultrasound can show abnormalities
including soft tissue abscesses or accumulation of fluid
(such as abscesses) and periosteal elevation. 2
Ultrasound can also be used to guide the conduct of
aspiration. However, ultrasound is not used to evaluate
bone cortex.
 TREATMENT

 acute osteomyelitis
resting the affected limb (if necessary use a splint or traction) and
immediately given antibiotics. Broad-spectrum antibiotics effective
against gram-positive and gram-negative given directly pending the
outcome of the bacteria culture. Antibiotics are given for 3-6 weeks
to see the general state of the patient and erythrocyte
sedimentation rate
 Osteomyelitis subacute
antibiotics in accordance with gram group, culture, and sensitivity
must be initiated intravenously for 2-7 days, followed by oral
antibiotics for 6 weeks
 Treatment of Chronic Osteomyelitis
 1. Antibiotics
Chronic osteomyelitis can not be treated with antibiotics
solely antibiotics aimed at:
• Preventing the spread of infection in an otherwise
healthy bones
• Controlling exacerbations

2. Measures operativeOperative procedure performed

when acute exacerbation phase has subsided after
administration and adequate antibiotic treatment.