Osteomyelitis
Osteomyelitis is a purulent inflammation of the bone marrow, bone and surrounding tissues. Osteomyelitis affects the entire bone, including the periosteum, compact and spongy substance. As a percentage of other common diseases of the musculoskeletal system, surgical intervention in osteomyelitis accounts for 6% of all cases. According to its etiology , osteomyelitis happens:
specific (syphilitic, tuberculous and brucellosis);
nonspecific;
hematogenic;
post – traumatic;
contact;
postoperative.
The content of the article:
Classification of osteomyelitis
Exogenous form
Acute osteomyelitis
Hematogenous osteomyelitis
Causes of hematogenous osteomyelitis
Post-traumatic osteomyelitis
Gunshot osteomyelitis
Postoperative osteomyelitis
Contact osteomyelitis
Treatment of acute osteomyelitis
Chronic osteomyelitis
Symptoms
Complications of chronic osteomyelitis
Diagnosis of chronic osteomyelitis
Treatment of chronic osteomyelitis
Osteomyelitis
The clinic will depend on the type of osteomyelitis, as well as whether it belongs to an acute or chronic form.
The treatment of acute osteomyelitis is based on the autopsy and further elimination of ulcers, chronic osteomyelitis involves surgical intervention with the removal of entire cavities, sequesters or fistulas.
Osteomyelitis occurs more often in the hips, shoulders, lower leg, spine, upper or lower jaws. An interesting fact is that most often post-traumatic osteomyelitis occurs after open fractures. It accounts for more than 16% of all cases.
Osteomyelitis is much more common among men than among women. If we talk about the prevalence of osteomyelitis relative to the age category, then children and the elderly often suffer from it.
Classification of osteomyelitis
Osteomyelitis can be specific and nonspecific. The cause of nonspecific osteomyelitis is pyogenic bacteria, including Staphylococcus aureus, E. coli, streptococcus, fungi. The cause of specific osteomyelitis can be considered bone tuberculosis, joint diseases, syphilis.
Regarding the image of the penetration of microbes into the bone, they talk about endogenous and exogenous osteomyelitis. Pathogens of endogenous osteomyelitis are introduced into the human body through the blood. It can be a remote focus (abscess, boil, panaritium, phlegmon, tonsillitis, an abrasion or wound on the body and even infected teeth). In the case of exogenous osteomyelitis, the penetration of infection occurs due to injury, surgical intervention or spread from near lying soft tissues and organs defeated by infection.
It should be said that already at an early stage, exogenous and endogenous osteomyelitis differ in their manifestations. After the time of its development, the obvious differences disappear and the forms of the disease proceed the same way.
Exogenous form
According to its varieties , exogenous osteomyelitis can be:
post-traumatic (occurs after an open fracture);
gunshot (a concomitant fact is a gunshot fracture);
postoperative (develops after surgery on the bones);
contact (the beginning is the transition of inflammation with a number of damaged tissues).
Osteomyelitis usually occurs in an acute form. An unfavorable outcome of treatment is its transition to a chronic form. In the case of atypical forms of osteomyelitis or infectious diseases such as syphilis, tuberculosis, the acute form of the disease may be completely absent, the inflammatory process itself will be of a primary inflammatory nature.
Acute osteomyelitis
The features of the manifestation of acute osmeomyelitis depend on the pathways of infection, the health of the body, the area of injury to the bone or near the underlying tissues. X-rays are able to detect changes in the human body, meaning the onset of osteomyelitis, as early as the 2nd week from the onset of the disease.
Hematogenous osteomyelitis
Hematogenous osteomyelitis usually begins to develop in childhood, most often in children under one year old. Very rarely, the cause of this type of osteomyelitis among adult patients is considered a relapse of the disease that was suffered in childhood.
Hematogenous osteomyelitis is characterized by its various manifestations, difficult recognition in the early stages, a sharp course and a violation of many functions of the human body. The femoral and tibial bones are most often affected.
The nature of the disease is determined by how timely the diagnosis was. Another important reason determining the successful or unsuccessful treatment of hematogenous osteomyelitis will be the effectiveness of a number of measures aimed at helping such patients.
According to statistics, hematogenous osteomyelitis is equally common among girls and boys. Most often there is a lesion of the upper jaw. There are cases of damage to several bones of the facial skeleton at once, but such cases are very rare.
Hematogenous osteomyelitis often occurs in children up to a month of life, whereas in the age group from 1 month to 1 year, the number of sick children is already 70%. Hematogenous osteomyelitis of the facial skeleton is often found among older children. The disease is characteristic of children aged 1-3 years (about 15% of all cases). Older children (3-10 years old) suffer from the disease less often, only 7% of all cases.
Causes of hematogenous osteomyelitis
The cause of hematogenous osteomyelitis is one of the foci of inflammation: soft tissue abscess, infected wound or phlegmon. It is from these foci of inflammation that microbes spread throughout the body with blood flow. As you know, the blood flow rate is usually suspended in the middle part of the long tubular bones. It is here that the settling of infectious agents occurs. With hypothermia and reduced immunity, microbes multiply very quickly, as a result of which hematogenous osteomyelitis develops.
Most often, there are such forms of the disease as septic-pyemic, local and adynamic forms:
The septic-pyemic form is characterized by an acute onset, although intoxication is weakly expressed. The body temperature can rise to 40 °, while accompanied by headache, chills, vomiting. A person may lose consciousness, he may be delirious, suffer from convulsions. In addition, hemolytic jaundice is not excluded. The patient is characterized by pallor of the skin, blue color of the mucous membranes and lips, the skin is often over-dried. With this form of osteomyelitis, low blood pressure and rapid pulse are noted, the spleen and liver increase in size (bronchopneumonia develops).
On the second day of the disease, a very severe pain of a drilling nature develops, which by its nature increases with the slightest movements in the area of the focus. There is swelling of soft tissues, the skin becomes hot, it is characterized by a red color. If it spreads to the nearest joints, purulent arthritis may develop. After 2 weeks, a focus of fluctuation begins to form, that is, fluid begins to accumulate in the soft tissues, after which pus penetrates into the muscle tissue with the formation of intermuscular phlegmon. If the phlegmon is not opened in a timely manner, it will further progress, leading to the appearance of another phlegmon — paraarticular type. Purulent arthritis or sepsis may also develop.
With the local form, there are no special changes in the general condition. As a rule, it remains satisfactory. There may be local signs of inflammation of bones or soft tissues.
The adynamic (or toxic) form is characterized by a lightning onset, symptoms of acute sepsis may prevail, which are expressed in an increase in body temperature, convulsions, toxicosis and loss of consciousness. As a rule, this form proceeds with a decrease in blood pressure and cardiovascular insufficiency. The symptoms of bone inflammation are usually poorly expressed, however, and manifest themselves quite late, thereby complicating the timely diagnosis.
Post-traumatic osteomyelitis
Post-traumatic osteomyelitis occurs in people with an open bone fracture. The disease develops well at the time of contamination of the wound due to injury. The risk of contracting this type of osteomyelitis is more typical for people with comminuted fractures and large-scale soft tissue injuries.
This type of osteomyelitis can affect all parts of the bone. In the case of linear fractures, the site of inflammation is limited only to the site of the fracture, whereas in the case of a comminuted fracture, the purulent-inflammatory process can spread. Post-traumatic osteomyelitis can occur in parallel with the hectic type of fever, severe intoxication in the form of weakness, headache and poor general health. Anemia or leukocytosis may also occur. The space in the fracture area is distinguished by its puffiness and soreness. Pus is released in large quantities from the wound.
Gunshot osteomyelitis
This type of osteomyelitis is formed in the case of extensive lesions of soft tissues and bones. The occurrence of the disease is influenced by stress, reduced immunity with the inability of the body to resist and inappropriate wound treatment.
The general symptoms of gunshot osteomyelitis are very similar to the first manifestations of post-traumatic osteomyelitis. As for the local symptoms, it is most often poorly expressed. Swelling of the extremities is usually moderate, a strong discharge of pus is not observed.
The first sign of osteomyelitis will be a change in the wound surface. Such a surface becomes dull, and deposits appear on it. In the future, inflammation can spread to absolutely all bone layers.
Usually, gunshot osteomyelitis ends with bone fusion. As for the purulent focus, it moves to the callus.
Postoperative osteomyelitis
Postoperative osteomyelitis is a type of post-traumatic type of this disease. Such a disease occurs after an operation on a closed fracture, during orthopedic operations, as well as due to the use of compression-distraction devices. Most often, the occurrence of postoperative osteomyelitis is associated with a lack of compliance with the rules of asepsis.
Contact osteomyelitis
The contact type of osteomyelitis is possible in the presence of purulent processes occurring in the surrounding soft tissues. Very often, this infection spreads to the bones, which can be the spread of an abscess, phlegmon or paranoia.
Treatment of acute osteomyelitis
Treatment of acute osteomyelitis occurs only within the walls of a hospital. During treatment, antibiotic therapy is carried out, taking into account the sensitivity of the body to microorganisms. Plasma transfusion and hemodesis are also performed. The latter is performed in order to reduce the overall intoxication of the body. If the disease has reached sepsis, then the method of extracorporeal hemocorrection is used.
In the treatment of acute osteomyelitis, it is important to carry out the procedure of drainage of a purulent focus. At an early stage of the disease, a trepanation hole is made, which is then washed with a solution of antibiotics.
Chronic osteomyelitis
If the treatment of patients with acute osteomyelitis is started in a timely manner, the percentage of restoration of the affected area of bone tissue will be greater than its destruction. The focus of necrosis will be completely replaced by a new bone, which can be considered a period of recovery. If there is no improvement, then the acute form of osteomyelitis becomes chronic.
No earlier than the 4th week of acute osteomyelitis, sequestration is observed (necrosis of a certain part of the bone, which is surrounded by modified bone tissue). In the second month of the disease, the sequesters peel off, and a free cavity appears in the area of the destroyed bone.
Symptoms
When the acute form of osteomyelitis becomes chronic, the general condition of the patient improves: he ceases to feel severe pain, the pains become aching, fistulous passages form, which sometimes come to the surface of the skin. A lot of pus can be released from the fistula cavity.
At the time of remission, the pain is dulled, purulent discharge becomes insignificant, and fistulas are scarce. Sometimes, fistulas can close. The duration of such remission is from several weeks.
A prerequisite for relapse may be parallel diseases, as well as reduced immunity. Closed fistulas usually lead to the accumulation of a large amount of pus. During a relapse, the limbs become hot, turn red and swell. The patient’s well-being will improve after the fistula is opened.
Complications of chronic osteomyelitis
The main complications of chronic osteomyelitis can be the formation of false joints, contractures, purulent arthritis, bone deformities. An open source of infection has a negative effect on the body as a whole, contributing to amyloidosis of the kidneys and changes in internal organs.
Diagnosis of chronic osteomyelitis
Diagnosis of chronic osteomyelitis is not difficult. To make an accurate diagnosis, an X-ray or tomography is prescribed. In order to detect fistulous passages, fistulography is performed.
Treatment of chronic osteomyelitis
Surgical intervention is prescribed in case of osteomyelitic ulcers, fistulas and false joints. Also, indications for surgery may be relapses with intoxication, severe pain and impaired functioning of the limbs or other organs.
The main type of surgery for chronic osteomyelitis is necroectomy, during which sequestration and granulation are eliminated with further excision of fistulas and drainage.
