Osteomyelitis

Dr/Wael H. Mansy, M.D.Assistant Professor

King Saud University

Objectives of this session:

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

Infection of the bone and bone marrow (osteo,

myelitis)

Mostly bacterial, can be fungal

Epidemiology

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:

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 7

Osteomyelitis

Usually subdivided clinically into: Pediatric Adult Hematogenous vs. Direct spread Special cases of Intravenous Drug

Abusers (IVDA) and Sickle cell Anemia.

Pediatric Osteomyelitis

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?

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. Staphylococcal aureus Streptococcus suppurefaticus. Hemophilus. influenza. Sickle cell disease: Long bone

osteomyelitis often due to salmonella.

Adult Osteomyelitis

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

IVDA: Hematogenous site more likely to be

spine or pelvis only occasionally to the long

bones.

Adult Osteomyelitis

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 17

Management: Admit

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

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

Follow up: can consider repeat ESR have it return to normal level.

Follow up films, radiologic recovery slower than clinical recovery