Classification
Acute osteomyelitis
1. Haematogenous osteomyelitis - primary infection in the blood or infection from other places through peradarahn blood. At risk in children. The bacteria attacks the blood vessel-rich areas and targentnya end of long bones.
2. Direct inoculation osteomyelitis - bacteria directly into the bone through a surgical procedure or trauma.
Chronic osteomyelitis
Acute osteomyelitis can become chronic, characterized by areas of dead bone. This condition often leads to failure in the treatment or medication to be a long process.
1. Primary
a. Children
b. Hematogenik
c. Septic arthritis
2. Secondary
a. Post open fracture
b. Post internal fixation
Etiology
Bones are infected by microorganisms either bacteria, fungi, and viruses, through the following conditions:
1. Contamination of the surgical procedure
2. Contamination of bone trauma
3. Infection in open fractures
4. Infection of the installation inplant / Prosthetic
5. Infection through the deployment limfohematogen from elsewhere
6. Infection in sepsis
Risk Factors
1. The old skin infection
2. Inadequate diabetic control
3. Impaired blood circulation (arteriosclerosis).
4. Risk factor for circulatory disorders including increased blood pressure, smoking, hypercholesterolemia and diabetes
5. Immune deficiency
6. Prosthetic joints
7. The use of intravenous drugs
8. Sickle cell anemia.
9. Cancer
Signs and Symptoms
1. Localized bone pain
2. The movement declined in the infected part
3. Overlying skin may be red, warm and swollen
4. The skin on it there pussy
5. Muscle spasm
6. BB decline unexplained
7. Lethargic
8. Increased body temperature
9. Sweaty
10. Fever
Diagnosis
1. Physical examination
2. Medical history
3. Blood tests: Signs of infection
4. X-rays: Squester and Involukrum
5. Bone scan
6. Computerised tomography (CT) scan
7. Magnetic resonance imaging (MRI)
8. Bone tissue biopsy.
Lab Studies
1. WBC increased, but often also normal
a. Increased polymorphonuclear leukocyte
b. Increased ESR (90%).
2. Normal culture 25% of cases, positive 50% with hematogenous osteomyelitis
Imaging Studies
1. Radiography
a. Shown in acute osteomyelitis with edema in the tissue above it pd 3-5 days after infection
b. Bone changes have not occurred within 14-21 days and after 28 days of 90% showed abnormal changes
c. Loss of 40-50% focal bone picture will appear dark on the film
2. MRI
a. Efektiof MRI for early detection and localization for surgical osteomyelitis.
b. The sensitivity of 90-100%.
3. Radionuclide bone scanning
a. Scan with technetium 99 m
b. In special circumstances a scan with gallium 67 and / or indium 111.
4. CT scanning
a. CT scans can detect abnormal calcification, ossifikasi and abnormal intrakortikal
b. Evaluation of lesions in the spinal vertebrae. Also very good for detetksi complex areas such as: pelvis, sternum, and calcaneus.
5. Ultrasonography
a. Simple and Inexpensive Technique can be done, especially for pediatric patients with acute osteomyelitis.
b. Ultrasonography will show changes immediately 1-2 days after onset of symptoms
c. Abnormalities detected include soft tissue abscess or fluid aumulasi and periosteal elevation
d. Not good for evaluation of bone cortex.
- Algorithm handling
1. Antibiotics IV
2. Consul / refer to the orthopedist or general surgeon
3. Infectious disease consultation
4. Selection of appropriate antibiotics culture results.
5. Surgery performed to remove the nidus of infection, implantation of the hose / pump antibiotics, hyperbaric oxygen therapy or other treatment
Treatment
1. Immobilization on the infected part
2. Culture = test sensitivity
3. Hospitalization and intravenous antibiotics
4. Long-term (4-6 weeks or longer) administration of oral or intravenous antibiotics.
5. Reliever medicines / pain relievers
6. Lifestyle changes, like quitting smoking
7. Treatment for the cause, such as diabetes.
8. Replacement of infected prosthetic part, if necessary
9. Surgery to clean and lift the infected bone (debridement / squestrektomi, drainage, replacement, bone graft, amputation)
10. Skin and bone grafts, if necessary
11. Amputation, in severe cases (necrosis)
12. At the appropriate fracture fixation did
Prognosis
1. Age
2. Nutrient
3. Type of bacteria
4. Fractures / (-)
5. Handling
Complication
1. Bone abscess (pus pocket)
2. Bone necrosis
3. The spread of infection
4. Soft tissue inflammation (cellulitis)
5. Sepsis (septicemia)
6. Chronic infections that do not respond to treatment
- Post Osteomyelitis Treatment
- Septic Osteomyelitis
- Post Osteomyelitis Scar
- Post Osteomyelitis Deformity of the Forearm
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