Acute osteomyelitis It is inflammation of the bone

Acute osteomyelitis • It is inflammation of the bone and its marrow. Aetiology. Most commonly – staph aureus, streptococci pyogens, strept. Pneumoniae, pseudomonas, proteus. Under 4 yrs of age, - haemophilous influenza.

Site of entry • Skin infection, cellulitis, boils, abscess. • Dental infection, IV canula, syringe, • ENT infection, lungs, UTI (catheter). PathophysiologyØ Port of entry blood metaphysis of bone (because it has high blood supply) blood stasis – deficient phagocytosis.

Ø Spasm of blood vessels in case of trauma hypoxia, inflammation stage of suppuration in chronic , stage of necrosis (sequestrum) stage of new bone formation stage of restoration and remodelling. Ø During inflamation • Venous stasis. • Polymorphonuclear cell migrant. • Exudate formation. • Thrombosis of vessels.

Ø Stage of suppuration. pus gets into joint cavity or medullary cavity. Ø Stage of necrosis. Because of venous stasis, thrombosis of vessels increase intraoseous pressure stripping periosteum by pus. Blood supply of the bone will be impaired that will lead to necrosis.

Ø Stage of new bone fomation. Formation of new bone takes place from the deeper layer of periosteum. Cl/ft; - find out h/o lesion at the entry site (primary site). - H/O trauma. - Pain and tenderness. - Fever, swelling. - Loss of function.

On examination- Increased local temperature. - Swelling , tenderness. - Lymphadenopathy. D/d 1. Cellulitis. 2. Septic arthritis. 3. Rheumatism. 4. Acute poliomyelitis.

Investigation; -CBC. -Pus for c/s. -blood for c/s. -stool for c/s- (salmonella). -X-ray, no positive findings till 1 -2 wks. After 2 wks, there will be soft tissue swelling. -MRI. -CT- scan. -USG- subperiosteal abscess.

Treatment; - Symptomatic. - Antiboitics. - Rest to limb. - Surgery for exploration and evacuation.

Management of acute osteomyelitis.

Complication- General complications- septicemia. - Local complications – septic arthritis. - pathological fractures. - growth plate damage. - Ch. Osteomyelitis.