OSTEOMYELITIS

(Femur debridement &

Bone cement Spacer with
External fixator)

-Nirbhay katiyar
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Femur Deridement:
 Doctors may recommend a procedure called
debridement to remove dead or damaged bone
tissue in people with osteomyelitis. During this
procedure, the doctor cuts away dead or
damaged bone tissue. He or she also washes the
wound to remove any dead or loose tissue.
 Osteomyelitis: Osteomyelitis is an infection in a
bone. Infections can reach a bone by traveling
through the bloodstream or spreading from
nearby tissue. Infections can also begin in the
bone itself if an injury exposes the bone to germs.
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Osteomyelitis:

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Example of Femoral spacer:

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 jess external fixator:
JESS frame provides adequate fixation of fracture in short operative time with
no further damage to soft tissue and requires only basic instruments for surgery
pathophysiology-osteomyelitis:

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HOW WOULD YOU KNOW if
SOMEONE is HAVING aN Osteomyelitis
or need femur debridement?

• Open wound that may show pus.

• Pain at the site of infection.
• Excessive sweating.
• Fever and chills.
• General discomfort, uneasiness, or ill feeling (malaise).
• Local swelling, redness, and warmth.
• Bone pain.
• In adults, osteomyelitis most often affects
the vertebrae of the spine and/or the hips
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DIAGNOSTIC EXAMINATION

• X-ray at the inflammation region

• CT SCAN.
• MRI (MRI has the highest accuracy to
detect osteomyelitis with a sensitivity of
90%)
• Tissue biopsy.

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Ideal therapeutic approach

 The most common treatments for osteomyelitis is surgery

to remove portions of bone that are infected or dead,
followed by intravenous antibiotics given in the hospital.
Surgery
 Drain the infected area.
 Remove diseased bone and tissue.
 Restore blood flow to the bone.
 Remove any foreign objects.
 Amputate the limb.

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How is osteomyelitis treated without
surgery?

 You'll usually take antibiotics for 4 to 6

weeks.
 If you have a severe infection, the course
may last up to 12 weeks. It's important to
finish a course of antibiotics even if you
start to feel better.

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Non-pharmacological interventions

 Hyperbaric oxygen therapy has also been proven effective in some

cases of osteomyelitis for four to 12 weeks at five days a week.
 (Hyperbaric oxygen therapy involves breathing pure oxygen in a
pressurized environment.)
 The primary care provider and nutritionist can complement the healing
process by focusing on improving comorbidities such as anemia,
diabetes mellitus and poor nutrition.

 There are some alternative methods used to treat osteomyelitis:

 While there are no herbs that specifically treat osteomyelitis, these
herbs may help strengthen your immune system and reduce infection:
1. Garlic (Allium sativum).
2. Siberian ginseng ,etc.

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CASE PRESENTATION
SUBJECTIVE DATA
 NAME: XYZ

 AGE: 13yrs

 SEX: MALE

 DEPARTMENT: Orthopaedic ward

 DATE OF ADMISSION: 12/10/2022

 DATE OF DISCHARGE: 18/10/2022

OBJECTIVE DATA
 COMPLAINTS ON ADMISSION:
• Pain and inflammation in left thigh (femoral bone): since 2
months
 & Pus discharge.
 History of present illness :
• Around 5 months back , fallen from tree and got a femoral
fracture.
• Then he went to the local hospital and they perform surgery to fix
it.
• Around 10-15 days after surgery inflammation occurs at the
operative area.
• 1 month later internal swelling and pus discharge started.

 PAST MEDICATION HISTORY: Not available.

VITAL SIGNS:
 BP: 120/81 mmHg
 PULSE : 72 beats/min
RR: 20/min
 Temp: 38.1 °C

LABORATORY INVESIGATIONS:
Blood test:
 HB: 10.1 (13-18 mg/dl )
TLC: 8650(4000-11000 cumm)
Neutrophils: 54.8(45-75%)
Lymphocytes: 34.3(20-45%)
Monocytes:
TRBC: 4.66(3.5-5.5mill./cumm)
PCV: 32.6(32-45%)
MCV: 69.9(78-98FL)
MCH: 21.7(27-32pg)
MCHC: 31.1(30-35gm%)
Platelet count: 4.02(1.5-4.5lacs/cumm)
Liver function test

 Serum bilirubin(total): 0.5 (0.2-1.2 mg/dl)

 Serum bilirubin(direct): 0.2 (0.0-0.25 mg/dl)
 Serum bilirubin(indirect): 0.30 (0.2-1.0 mg/dl)
 AST/SGOT: 14 (0-35 U/L)
 ALT/SGPT: 11 (0-35 U/L)
 Serum alkaline Phosphatase: 230 (80-290 IU/L)
 Serum total protein: 6.8 (6-8 g/dl)
 Serum albumin: 3.3 (3.5-5.2 g/dl)
 Serum globulin: 3.5 (2.3-3.6 g/dl)
renal function test
 S.Urea: 9 (10-50 mg/dl)
 S.Creatinine: 0.60(0.6-1.6 mg/dl)

OTHER INVESTIGATIONS:
X-Ray:
x-ray of left femur (AP & lateral)

ECG:
Normal
HPE(histopathological examination)
biopsy report:
 Specimen: bone tissue

 Section show fragments of lamellar bones &

Woven bones with fibroblastic proliferation
associated with few inflammatory cell infilterates.
 There is presence of mineralization in osteiod .
 (OSTEOID is the unmineralized, organic portion of
the bone matrix that forms prior to the maturation
of bone tissue)
ASSESSMENT
 Based on the subjective data and
objective data, the patient was
diagnosed with
Osteomyelitis
 & Femoral Debridement is required.
 MEDICATION CHART
DRUG DOSE FREQUENCY ROUTE NO.OF REMARKS
DAYS
T.DOLO 500mg T.I.D P/O 2 HOLD
(Paracetamol)

T.Ibugesic plus 325 & 400 T.I.D P/O 2 HOLD

(paracetamol & mg
ibuprofen)

Amoxicillin and 500 & 125 1-0-1 P/O 7 Day 3 to

potassium mg CONTINUE
clavulanate
Pantop 40mg 1-0-0 P/O 7 CONTINUE
(pantoprazole)

T.Calcium & vit D3 500mg & 0-1-0 P/O 7 CONTINUE

250 IU

Aceclofenac & 100 mg & 1-0-1 P/O 7 From day 3

paracetamol 325mg continue

Inj. ceftriaxone 500 mg 1-0-1 IV 2 HOLD

T.Ondensetron 4mg 1-0-1 P/O 6 CONTINUE

DISCHARGE MEDICATION

1. Amoxicillin CV (500 & 125 mg) 1-0-1

2. T.Calcium & vit D3 (500mg &250 IU) 0-1-0
TO CONTINUE
3. Cap.Pantop (40mg) 1-0-0
4. T.Aceclofenac &paracetamol
 (100mg &325mg) 1-0-1

 Continue for 10 days then contact your doctor

with X Ray (AP/ lateral)
 DISCUSSION ON THERAPY
GENERIC CLASS INDICATION MOA ADR
NAME
Inj.  Cephalosporin to treat  works nausea,
ceftriaxone antibiotics bacterial by inhibiting vomiting, pain
infections in the in your upper
many different mucopeptide stomach that
parts of the synthesis in spreads to your
body. the bacterial back; pale or
cell wall. yellowed skin,
dark colored
urine; new or
worsening
breathing
problems .
GENERIC CLASS INDICATION MOA ADR
NAME
Cap.Pantop D  Gastro- Inhibit the proton Loss of
PPI & esophageal pump and balance,
domeperidon reflux disease, reduce the Increased bone
e is Heartburn, gastric fractures, Skin
D2 receptor Esophagus secretions.  itching,
antagonist inflammation, Diarrhea.
Stomach ulcers
T.Calcium & NA low calcium vitamin D is the  gas,
vit D3 levels such as maintenance of constipation,
bone loss normal levels bloating,
(osteoporosis), of serum nausea/vomiti
weak bones calcium and ng, loss of
(osteomalacia/ri phosphorus appetite,
ckets), in the mental/mood
decreased bloodstream by changes, and
activity of the enhancing the bone/muscle
parathyroid efficacy . pain.
gland
(hypoparathyroi
dism), and a
certain muscle
GENERIC CLASS INDICATION MOA ADR
NAME
T.Acceclofen NSAIDs & Reduce pain Aceclofenac Dizziness.
Antipyretic and fever acts by Drowsiness.
ac &
paracetamol inhibiting Dyspepsia.
certain Abdominal
enzymes pain.
responsible for Nausea.
the formation Diarrhoea.
of
prostaglandin,
thus helps in
relieving pain
and reduce
swelling
GENERIC CLASS INDICATION MOA ADR
NAME

T.Amoxicillin penicillins  to treat certain It works by  pain or

and and beta- infections killing the tenderness in
potassium lactamase caused by bacteria and the upper
clavulanate inhibitors bacteria, preventing stomach, pale
including their growth stools, dark
infections of urine, loss of
the ears, lungs, appetite,
sinus, skin, nausea,
and urinary vomiting, or
tract yellow eyes or
skin

T.ONDANSE serotonin 5-  to prevent  blocking the headache.

TRON HT3 receptor nausea and action of constipation.
antagonists. vomiting that serotonin, a weakness.
is caused by natural tiredness.
medicines substance chills.
(chemotherapy that may drowsiness.
) or radiation cause nausea
therapy and vomiting.
DRUG INTERACTIONS
 No any drug interaction found.
PHARMACIST INTERVENTION
Aceclofenac , paracetamol and
Serratiopeptidase combination will be more
effective in case of Aceclofenac and pcm.
Educate patient about medication
compliance.
Provide deep venous thrombosis and
pressure sore prophylaxis.
Improve muscle strength and functioning
by normal stretching .
PATIENT COUNSELLING
 ABOUT DISEASE

1. If inflammation is not gradually decreasing then consult with the

doctor with X –Ray imaging.
2. Pus discharge should be stopped.
3. Maintain hygienic conditions.
4. Change and monitor your bandage properly as directed by the
doctor.
5. Assess nutritional needs and promote bed rest.

 ABOUT DRUGS
 T.Pantop D:
• It should be taken empty stomach to reduce gastric irritation.
• If you miss any drug dose continue with the next dose , do not take
more than prescribed pill at a time.
 On facing any discomfort because of the medicine talk to the doctor.
LIFESTYLE MODIFICATIONS
 Do not move to much and don’t plan for travelling .
 Maintain hygienic conditions.
 Cover your wound for reducing the chance of infection.
 Use dairy products like Milk , yogurt etc.
 Increasing your consumption of fresh fruits and vegetables,
whole grains and fish.
 Spinach may be a beneficial food in treating your
osteomyelitis, due to its high vitamin A content.
 After being recover regular exercise is essential. Adults
aged 19 to 64 should do at least 1 hours and 30 minutes of
moderate-intensity aerobic activity. 
 Eat fish and poultry instead of red meat . Fish contains so
called healthy fats –unsaturated fats.
Thank you