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Referat Osteomyelitis

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Osteomyelitis
1
22 April
2019
Dexel Putra P.S Simbolon
120610033
Preseptor: dr. M. Bayu Rizaldy, M.Ked (Surg) Sp.OT
BAGIAN/SMF ILMU BEDAH
FAKULTAS KEDOKTERAN
UNIVERSITAS MALIKUSSALEH
RUMAH SAKIT UMUM CUT MEUTIA
ACEH UTARA
2019
EPIDEMIOLOGY
The overall prevalence is 1 case per 5,000 children. The
prevalence of neonates is around 1 case per 1,000 events. The
prevalence of osteomyelitis after trauma to the foot is around
16% (30-40% in patients with DM). Acute hematogenous
osteomyelitis is common in children, boys are more often
affected than women (3: 1). The bones that are often affected are
the longest and most common bones are the femur, tibia,
humerus, radius, ulna, fibula.
 In adults hematogenous infections are usually the most
common in the vertebrae compared to long bones.
 Adults are exposed to a decrease in body defenses due to
weakness, illness or drugs. Diabetes is also associated with
osteomyelitis, transient or induced immunosuppression
increases predisposing factors, trauma determines the site of
infection, probably caused by a small hematoma or
accumulation of fluid in the bone
ETIOLOGY
Staphylococcus aureus is the most
common organism causing acute
osteomiletis, which is acute, which is
approximately 90% of cases.
The entry point of bacteria is
through injured and infected skin, blisters,
and pimples or boils. Sometimes it can also
be through the mucous membrane of the
mucous membrane of the upper airway as
a complication of infection of the throat or
nose. In addition, other bacteria that can
cause osteomyelitis are Streptococcus and
Pneumococcus, especially in infants.
The most common organism causing osteomyelitis is based on
the age of the patient:
Infants
(<1 year)
-
Grup B Streptococci
Staphylococcus auereus
Escherichia coli
Children
(1 - 16 years)
-
Staphylococcus auereus
Streptococcus pyogenes
Haemophilus influenzae
Adults
(> 16 years)
-
Staphylococcus epidermidis
Staphylococcus auereus
Pseudomonas aeruginosa
Serratia mercescens
Escherichia coli
OSTEOMYELITIS
Routes of infection
1.
2.
3.
Hematogenous spread, most common.
Extension from a contiguous site.
Direct implantation.
OSTEOMYELITIS:
Sites of involvement:
 The long bones of the
extremities are most
commonly involved
 The most common sites are the
distal femur and proximal tibia
metaphysis
metaphysis
 Metaphysis
OSTEOMYELITIS
Sites of involvement:
 Influenced by the vascular circulation, which varies with age.
 Neonates: the metaphyseal vessels penetrate the growth
plate, resulting in frequent infection of the metaphysis,
epiphysis or both.
 Children: metaphyseal.
 Adults: epiphyses and subchondral regions.
OSTEOMYELITIS
Risk factors
It occurs most frequently in children and young adults.
2. Diabetes mellitus (especially involving the foot)
3. Compromised immunity (including AIDS)
4. Sickle-cell disease
1.
OSTEOMYELITIS
Stages :
 Acute
 Sub acute
 Chronic.
OSTEOMYELITIS
Pathophysiology
 Necrosis of the bone within first 48hrs.
 Spread of bacteria and inflammation within the shaft of the
bone and may percolate through the haversian systems to
reach the periosteum.
 In children, the periosteum is loosely attached to the cortex;
therefore sizable subperiosteal abscess formation occurs.
 Further ischemia and bone necrosis occurs.
OSTEOMYELITIS
SEQUENCE OF INFECTION:
 Once localized in bone, the bacteria proliferate and induce an
acute inflammatory reaction and cause cell death.
 Dead pieces of bone is known as the sequestrum.
sequestrum
 After the first week chronic inflammatory cells become more
numerous with the release of cytokines and deposition of new
bone formation at the periphery.
 New bone may be deposited as a sleeve of living tissue known
as the Involucrum
Involucrum
 Brodie abscess:
is a small intraosseus abscess that frequently
involves the cortex and is walled off reactive bone.
In infants epiphyseal infection may
spread to the adjacent joint and
causes septic or suppurative arthritis;
may lead
to permanent disability.
Pathophysiology of osteomyelitis
 The primary site of infection is
usually in the metaphysial region
•The infection may spread to
involve the cortex and form a
subperiosteal abscess; may spread
into the medullary cavity
•Rarely, may spread into the
adjacent joint space.
sequestrum
OSTEOMYELITIS
OSTEOMYELITIS
 Clinical Course:
 Fever ,chills, malaise, marked to intense
throbbing pain over the affected region.
 Diagnosis;
 Sign/symptoms.
 X-ray: a destructive lytic focus
surrounded by edema and a sclerotic rim
 Blood cultures: +ve in 70%
 Biopsy
OSTEOMYELITIS
Rx :
 Pain relief
 Parenteral antibiotics for at least 2 weeks, followed by oral
antibiotics for at least 4 weeks
 Surgical decompression and removal of any dead bone
 Rehabilitation.
OSTEOMYELITIS
Chronicity may develop with:
 delay in diagnosis
 extensive bone necrosis
 abbreviated antibiotic therapy
 inadequate surgical debridement
 weakened host defenses
OSTEOMYELITIS
 Complications:
 Pathologic fracture.
 Secondary amyloidosis
 Endocarditis
 Sepsis
 Squamous cell carcinoma if the infection creates a sinus tract.
 Rarely sarcoma in the affected bone
Thank You.
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