OSTEOMYELITIS

Elfira Sutanto
31.191.021
 M. Syamsul Al-Falah, 10 yo, 416-23-63, JKn

Chief Complaint
Pain on left knee since 4 days before admission.
Chief Complaint
The patient was flying a kite 4 days before admission when he tripped
himself, fell on his left knee, leaving painful bruise and swelling on his
left knee. Following the incident, the patient got fever, but did not shiver.
The patient visited a nearby clinic where he was given analgesics. There
was also vomiting and diarrhea. Without any improvement of the pain
and fever, the patient came into our emergency department.
There was no history of previous coughing, cold, night sweat, toothache,
painful micturition.
 LABORATORY 2/1/17
• CBC : 14.4/44.3/11.3/171
PT/APTT : 1.1x/1.2x ESR : 41
AST/ALT : 55/20 PCT : 573.2
Ur/Cr : 118/3.6 CRP : 470.0
Na/K/Cl : 127/3.3/100 Lactic acid : 2.3
RBG : 125 Uric acid : 15.3
SER : 60 ALP : 218
LDH : 689
 LABORATORY

2nd Jan 9th Jan

ESR 41 120
PCT 573.2 1.77
CRP 470 174
Na/K/Cl 127/3.3/100 138/4.8/98.9
Ur/Cr 118/3.6 27/0.6
Uric acid 15.3 1.6
Blood culture No organism growth
LOCAL STATE OF LEFT KNEE
Look
Local swelling with bruise on
anterolateral side. No deformity,
hyperemia, edema, wound, or
sinus was seen.
Feel
Tenderness VAS 3-4, overlying
skin was warmer than
surrounding, CRT < 2 sec, tibialis
posterior and dorsalis pedis artery
pulsation +2, normal distal
sensorium.
• Move
ROM of left knee was
limited due to pain
X-RAY OF LEFT KNEE
X-RAY OF LEFT KNEE
MRI OF LEFT KNEE
MRI OF LEFT KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
MRI OF
LEFT
KNEE
 M. Syamsul Al-Falah, 10 yo, 416-23-63, JKN

DIAGNOSIS PERFORMED

Acute osteomyelitis of left • Debridement

distal femur • Intraosseous
decompression
Ressolved hyperuricemia • Open biopsy
Ressolved Acute kidney injury

Date 11th January, 2016

Implant -
Vendor -
 Intraoperative

Draping
First Incision

Distal Proximal
 Intraoperative

Subperiosteal Abscess Debridement and Irrigation

Distal Proximal
 Intraoperative

Intraossesous Biopsy (Intramedullary and

decompression Periosteal Tissues)

Distal Proximal
 Intraoperative

Bone Window Wound Closure

Distal Proximal
 Intraoperative

Immobilization using backslab

Distal Proximal
POSTOPERATIVE X-RAY
ANATOMI
 DEFINISI
•Merupakan infeksi pada tulang
•Akut dan kronis
 EPIDEMIOLOGI
•Insidensi osteomielitis di US tidak diketahui pasti, laporan menyatakan adanya 1 dalam
675 rawat inap di rs setiap tahunnya
•Studi lainnya: 21,8 kasus per 100.000 orang per tahun
•Insidennya meningkat pada pria, usia lanjut, DM, penyakit vaskuler
 ETIOLOGI
•Staphylococcus aureus
•Streptococcus pyogenes
•Streptococcus pneumonia
•Haemophilus influenza
•Kingella kingae
•Pseudomonas aeruginosa
PATOFISIOLOGI
CIERNY MADER
CLASSIFICATION
CIERNY MADER
CLASSIFICATION
 ANAMNESIS
•akut: muncul gejala beberapa hari sampai 2 minggu pasca kejadian. Gejala bengkak,
kemerahan, hangat pada bagian yang terkena, nyeri, demam
•Subakut: malaise, nyeri ringan selaman beberapa minggu, demam dan nyeri minimal
•Kronis: gejala > 2 minggu. Adanya bengkak, nyeri, kemerahan pada bagian terkena, gejala
konstitusional tidak ada biasanya
•Resiko osteomielitis: bakteremia, IV drug user, endokarditis, trauma, fraktur terbuka, DM,
penyakit vaskuler, neuropati atau penggunaan orthopedic hardware
PEMERIKSAAN FISIK
 PEMERIKSAAN PENUNJANG
Lab darah: darah lengkap (leukositosis, LED meningkat), CRP meningkat, kultur darah
Imaging: foto polos pada bagian yang terkena, Pet, ct-scan, biopsi tulang
• Sekuestrum (bangunan dense dikelilingi
lusentulang yang mati dikelilingi oleh pus)
• Involucrum (pembentukan tulang baru di sekitar
tulang yang mengalami destruksi)
• Brodie’s abcess (di dalam spongiosa dekat ujung
tulang  abses bulat/oval, lusen dengan batas tegas
dikelilingi zona sklerotik, biasanya tanpa sekuester
dan tanpa elevasi periosteal
 DIAGNOSIS BANDING
•Tumor tulang
•Bone healing fracture
 TATALAKSANA
Non operative: antibiotik
Operative: irigasi dan debridement+ AB sesuai kultur; amputasi
TATALAKSANA
 PROGNOSIS
Prognosis baik apabila ditanganin dengan agresif saat osteomielitis akut
Dapat rekurensi jika terjadi trauma berulang pada daerah yang sama
+immunocompromised
Infeksi p.aureginosa rekurensinya setinggi 50%
Antibiotik profilaksis pre operative (30 menit sebeulm operasi) dengan cephalosporin
generasi 1 atau 2 menurunkan infeksi postoperative sebanyak 0,5%-2%
 KOMPLIKASI
Septic arthritis
Fraktur patologis
Deformitas tulang