TYPES ,CLSASSIFICATION PATHOGENESIS OF

OSTEOMYELITIS

Classification :
Acute hematogenous osteomyelitis
Acute osteomyelitis
Chronic osteomyelitis
Subacute osteomyelitis

Acute hematogenous osteomyelitis

Infection caused by blood borne organism
Children boy
Ro: acute soft tissue swelling (early), bone demineralization (10 to
14 days), and sequestra (dead bone with sorounding granulation
tissue) and involucrum (periosteal new bone) (later).

Acute osteomyelitis: (after open fracture or after open reduction with

internal fixation)
Clinical = acute hematogenous osteomyelitis.
Treatment: radical irrigation, debridement, removal of orthopaedic
hardware
Organisms are: S.aureus, P.aeruginosa, coliforms

Chronic osteomyelitis: may arise as a result of an inappropriately

treated acute.o, trauma, soft tissue spread in the immunosuppressed
patient, diabetics, and i.v drug abusers.
Treatment: debridement + bone grafting + soft tissue coverage +
i.v antibiotics + amputations?

Subacute osteomyelitis: is usually discovered radiologically in a patient

with a painful limp and no systemic (and often no local) signs or
symptoms.
Three Ways of Infection
Hematogenous
Through the bloodstream

Contiguous focus
Extension from adjacent tissue infection
 Direct infection into the bone

Osteomyelitis - Organisms
Staphylococcus spp Aureus 80 90 %
E. Coli
Pseudomonas
N. gonorrhoeae
Proteus spp
Group B streptococci
H. influenzae
Salmonella in SCD

Osteomyelitis - Bone affected

Any bone (Haematogenous vs. direct route)

Ends of long bone
Metaphysis of long bone adjacent to actively growing ECP
At the metaphysis, the BM spaces become dilated favouring sluggish
circulation ideal for multiplication of bacteria.
Vertebral column
Osteomyelitis Direct Extension
Dental abscess
Penetrating wounds
Contamination of compound fracture
Following surgery
Foreign body (e.g. implants, surgical device)
Acute purulent frontal sinusitis
Deep pressure sore (leading to Osteomyelitis of sacrum)

Osteomyelitis - Haematogenous Route

Suppurative infections e.g. abscess, boil, OM
Endocarditis
URTI
Genitourinary surgery
Drug addicts
 Clinical Manifestations
If hematogenous, common sepsis manifestations:
Chills
High fever
Rapid pulse
General Malaise

Clinical Manifestations
At first, systemic sx may overshadow the local signs
Constant, pulsating pain that intensifies with movement
Swollen and tender area of infection
Chronic Osteomyelitis presents continuously draining sinus or
recurrent inflammation
 Findings in infants include the following:

Failure to thrive
Drowsiness but irritability
Minimal constitutional symptoms
Effusions into neighboring joints (60%)

Diagnostics
CBC
ESR
Blood Cultures
Superficial Cultures
Biopsy
X-Rays
Radionuclide Bone Scans
MRI

Complications of osteomyelitis /1
1. Septicemia disseminated abscesses, infective carditis
2. Septic bacterial arthritis
3. Pathological fractures
4. Alteration in growth rate
5. Squamous cell carcinoma
6. Amyloidosis
7. Chronic osteomyelitis

Complications of osteomyelitis /2
8. Vertebral related Complications
a. Neurological manifestations
b. Vertebral collapse
c. Paravertebral abscess
d. Spinal epidural abscess
e. Cord compression
f. Compression fracture
 T.B. Osteomyelitis
1/3 population infected.
Over 2 million people in Pakistan have TB.
80,000 develop Pul. TB every year.
Total 2 million.
10,000 die of TB.
LEADING CAUSE OF DEATH.
1 3% skeletal TB

TB
Cause by Mycobacterium tuberculosis, occasionally by
M.bovis/africanum.
Also known as tubercle bacilli as they produce lesion tubercles.
Acid fast bacilli.
Transmission airborne droplets.
Risk- extent of exposure to droplets and susceptibility to infection.

Bone tuberculosis
Spread from primary complex to any bone/joints.
Can effect any bone but the weight bearing bones are more likely to be
affected.
Spine commonest, hip, knee, foot.

Stages of articular TB
1 synovitis.
2 early arthritis.
3 advanced arthritis.
4 adv. Art. Pathological dislocation / subluxation.
5 after math terminal of gross arthritis.

TB - Types
Caseous exudative
more destruction, exudation & abscess formation.
Symptoms more marked.
Onset is less insidious.
 Granular type
less destructive.
Abscess formation rare.
Dry lesion.
adults
TB SPINE -Classification
1- pre-destructive
2- early destructive.
3- mild angular kyphos.
4- moderate angular kyphos.
5- severe kyphos (humpback)

TB Spine
C/F:Back pain of variable duration, fever and weight loss.
O/E: local tenderness, spasm, mild kyphosis-late Gibbus, cold abscess
and paraparesis.
DIAGNOSIS: XRAY-erosion of the anterior edges of the superior and
inferior boarders of adjacent vertebral bodies with narrowing of disc
space.
USG :paravertebral abscess.
Biopsy/ CT scan

TB Hip
C/F: pain/limping, irritable hip child. Gradual loss of range of
movement, flexion deformity, wasting of thigh muscles.
Xray: both hip to compare.Early changes rarefaction of the bone and
widening of the joint space, later destruction of the joint.
Synovial bioposy.

Complications of Potts Disease

Cold abscess formation (i.e. no acute inflammation, necrotic debris,
caseation).
Rupture into soft tissue along anterior spinal ligaments cold
paraspinal abscess.
Spread along psoas muscle cold psoas abscess
Spinal cord compression leading to paraplegia
Angulations of spine
 Chronic Osteomyelitis
If the process fails to abate completely in 4 to 6 months, regular
exacerbations occur, fistulae remain, and the discharge of pus
continues, then it is considered that osteomyelitis has taken the
chronic stage.

This outcome depends on the severity and rate of the occurring

alternative changes in the bone tissue and how early and properly is
the treatment applied. A change to the chronic stage may be
encountered in 10 to 30 per cent of cases.
Chronic osteomyelitis
 Sclerosing osteomyelitis of Garr
Ollier's albuminous osteomyelitis.
Chronic recurrent osteomyelitis
osteomyelitis In sickle cell anaemia
Xanthogranulomatous osteomyelitis
Chronic recurrent multifocal osteomyelitis

Mycotic osteomyelitis
Syphilis