Transcript 9-osteomyelitits

Osteomyelitis
Dr/Wael H. Mansy, M.D.
Assistant Professor
King Saud University
Objectives of this
session:
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Familiarize the audience with major types of
Osteomyelitis, relationship to the age of the
host, mechanism of infection, bacteriology of
the disease.
Clues that help in the diagnosis
Overview of the management of
Osteomyelitis.
Osteomyelitis: Definition
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Infection of the bone and bone marrow (osteo,
myelitis)
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Mostly bacterial, can be fungal
Epidemiology
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Pre-antibiotic era had 25% mortality
Significant morbidity/disability worldwide due to
lack of access to care
Leading cause for amputations in the US
Significant cause of pediatric disability
worldwide.
Prevalence:
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Children 1: 5000
Sickle cell patients 3.6: 1000
Post puncture wound to foot 16%
Neonates 1: 1000
Post puncture wound to foot in
diabetics 30 – 40%
Higher in developing countries
Jose R. Jimenez MD, UTHCT
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Osteomyelitis
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Usually subdivided clinically into:
Pediatric
Adult
Hematogenous vs. Direct spread
Special cases of Intravenous Drug
Abusers (IVDA) and Sickle cell
Anemia.
Pediatric Osteomyelitis
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Hematogenous spread affecting
the long bones.
Usual sites are the long bones:
tibia, humerus, femur.
Some to Spine: direct contact (TB)
Why the long bones?
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Non-anastomosing capillary ends of nutrient
arteries form sharp loops under the growth
plates and enter large venous sinusoids
where the blood flow is slow and turbulent,
trapping the organisms.
Usual causative
organisms: Pedi. Osteo.
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Staphylococcal aureus
Streptococcus suppurefaticus.
Hemophilus. influenza.
Sickle cell disease: Long bone
osteomyelitis often due to
salmonella.
Adult Osteomyelitis
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Most Cases: Direct extension of infection to the
bone from a skin ulceration, leading cause of
amputations
Direct
inoculation to the bone from an
open/contaminated fracture.
Hematogenous from IVDA
Adult Osteomyelitis
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IVDA: Hematogenous site more likely to be
spine or pelvis only occasionally to the long
bones.
Adult Osteomyelitis
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Most common: Foot ulcer extending into the bony
structures.
Neuropathic foot ulcer
Mixed infection is common with s.aureus, Gram
negatives, some strep.
Open fractures
Infected prostheses
Foot injuries
Jose R. Jimenez MD, UTHCT
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Management: Admit
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OrthoSurg consultation
Closed needle biopsy/drainage
C/S obtained
Started on I.V. vancomycin
empirically
Switched to oxacillin after C/S
grew meth. Sensitive staph. A.
Hosp. Course
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Over 6 to 8 days on I.V. antibiotic
therapy, patient became afebrile,
leg tenderness subsided, less pain
w/ ambulation.
On 9th day patient switched to oral
penicillin, sent home to complete 6
weeks of therapy.
Full recovery when seen for follow
up visit in clinic.
Osteomyelitits
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Follow up: can consider repeat
ESR have it return to normal level.
Follow up films, radiologic recovery
slower than clinical recovery