OSTEOMYELITIS &

SEPTIC ARTHRITIS
 OSTEOMYELITIS

 Bone destruction caused by inflammatory
response to an infective microorganism.

Bone Infection

 Infection could be localised or infiltrated

to the periost, medullar canal, cortex and
surrounding soft tissues.
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 Osteomyelitis

Classification:
 Duration Acute, Subacute or Chronic
 Route of infection Hematogenous or Exogenous
 Host response Pyogenic or Granulomatous

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 Acute Pyogenic
Osteomyelitis

Incidence:
 Age more in children
 Sex M>F
 Bone affected all bones
 Site of infection metaphysis

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 Acute Pyogenic
Osteomyelitis

Organism:
 Neonates:
Staph aureus, Strept, E coli
 Children:
Staph aureus, E coli, Serriata, Pseudomonas, H
inf
 Sickle-cell anemia:
Staph aureus, Salmonella

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 Acute Pyogenic Osteomyelitis

Source of Infection:
 Hematogenous
 Direct spread
 Exogenous

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 Acute Pyogenic Osteomyelitis

Pathology:

 Primary focus: Inflammation stage
 Pus formation
 Subperiosteal abscess formation
 Pus drainage from a sinus tract
 Bone infarction (Sequestrum)
 New bone formation (Involucrum)
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 Acute Pyogenic Osteomyelitis
Clinical Pictures 
History: Any possible infection?
Skin lesion
Sore throat
Trauma

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 Acute Pyogenic Osteomyelitis

Clinical Pictures

Symptoms:
 Pain, restless
 Malaise and fever
 The limb is held still (pseudo
paralysis)
 Sometimes mild or absent
(neonates) 9
 Acute Pyogenic Osteomyelitis

Clinical Pictures
Signs:
General (fever),
Local (redness, swelling,
warmth)

Laboratory Tests:
 CBC
 ESR+CRP
 Blood culture (+ve in 50-70%)
 10
Aspiration (Gram stain + culture and sensitivity)
 Acute Pyogenic Osteomyelitis

Radiography

 Plain X-ray
 Ultrasound
 Bone & gallium scan
(Sensitive but not
specific)
 CT scan
 MRI 11
 Acute Pyogenic Osteomyelitis

Differential Diagnosis
 Acute Septic Arthritis
 Acute monoarticular
rheumatoid arthritis
 Sickle cell crisis
 Cellulitis
 Ewing’s Sarcoma

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 Acute Pyogenic Osteomyelitis

Treatment

General:
 Hospitalization
 Hydration
 Electrolyte replacement
 Analgesia

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 Acute Pyogenic Osteomyelitis

Treatment

Antibiotics:
 Type?
 Route?
 When to start?
 When to stop
 Monitoring?

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 Acute Pyogenic Osteomyelitis

Treatment

Surgical Drainage:
 Indications?
 Procedure?
 Drilling?

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 Acute Pyogenic Osteomyelitis

Prognosis
Factors affecting prognosis:
 Organisms
 Infected Bone
 Age of the Patient
 Treatment

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 Acute Pyogenic Osteomyelitis

Complications
 Septicemia & metastatic abscesses
 Septic arthritis
 Growth disturbance (children)
 Pathological fracture
 Chronic osteomyelitis

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 Subacute Osteomyelitis

 Longer history and less virulent organism

 Insidious onset, Mild symptoms

 Pain is the most consistent symptom

 Usually no constitutional symptoms

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 Subacute Osteomyelitis

 Abnormal initial radiographs
 Inconclusive laboratory data
 Negative cultures/ biopsy
 Difficult to distinguish from
bone tumors e.g. Ewing’s,
osteosarcoma
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 Chronic Osteomyelitis

Factors responsible for chronicity
 Local factors: Cavity, Sequestrum, Sinus,
Foreign body
 General: Nutritional status of the involved
tissues, vascular disease, DM, low immunity
 Organism: Virulence
 Treatment: Appropriateness and compliance
 Risk factors: Penetrating trauma, prosthesis,
Animal bite 20
 Chronic Osteomyelitis
Clinical picture

 Continuous or intermittent suppuration and
sinus formation with acute exacerbations.
 Pain, fever, redness, and tenderness during
acute attacks.
 Discharging sinus with +ve/-ve culture.
 Pathological fracture.
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 Chronic Osteomyelitis
Investigation

 Lab tests/ culture
 Plain X-ray:
Bone infarction surrounded by
the dense sclerosis, sequestration
and cavity formation
 Sinogram
 Bone scan & gallium scan

To detect chronic multifocal

osteomyelitis
 CT Scan & MRI
 Biopsy
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 Chronic Osteomyelitis

Treatment
 Antibiotics
 Surgical treatment
Preoperative assessment & preparation
Debridement
Sequestrectomy
Local antibiotics
Stability
Treatment of bone cavity
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 Chronic Osteomyelitis

Complications
 Recurrence & Recurrence & Recurrence
 Pathological fractures
 Growth disturbance
 Amyloid disease
 Epidermoid carcinoma of the fistula

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 Septic Arthritis

 Infection of the joint
 Usually bacterial
 Viral arthritis: Self limiting, supportive
treatment
 50% children <3 years
 The hip joint is the common site in <3 years
 The knee joint is more common in >3 years

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 Septic Arthritis

 Risk factors
 Age> 80 years
 Medical conditions (diabet, rheumatoid
arthritis, HIV)
 History of crystal arthropathy
 Endocarditis or recent bacteremia
 IV drug user
 Recent joint surgery
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 Acute Septic Arthritis

 Organism? –staphylococcus aureus most
common
 Route of infection?
bacteremia
direct inoculation (from trauma or surgery)
contiguous spread (from adjecent
osteomyelitis)

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 Acute Septic Arthritis

Clinical Pictures
 General manifestations:
constitutional symptoms and signs of acute
infection
 Local manifestation:
Swelling, tender hotness and redness
Deformity with muscle spasm
Restriction of all movements of the joint
The joint is fixed in the position of ease
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 Acute Septic Arthritis

Investigations
 Plain X-ray (joint space widening,
periarticular osteopenia)
 Ultrasound (joint effusion)
 MRI (osteomyelitis)

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 Acute Septic Arthritis

Investigations
 WBC>10.000
 ESR>30
 CRP>5 (most helpful)
 Joint fluid aspirate (gold standard)

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 Acute Septic Arthritis

Differential Diagnosis
 Acute osteomyelitis
 Transient synovitis of the hip (<10)
 Acute rheumatic fever
 Haemoarthrosis
 Haemophilic arthritis
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 Acute Septic Arthritis

Treatment
 Aspiration
 Antibiotics
 Surgical drainage
 Treatment of complications

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 Acute Septic Arthritis

Complications
 Arthritis
 Fibrous ankylosis
 Osteomyelitis

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 

THANKS...

dr.myalcinozan
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