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Similar to Abah Presentation osteomyelitis management.ppt
Abah Presentation osteomyelitis management.ppt
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- 2. Classification Of Osteomyelitis •Acute hematogenous osteomyelitis • Subacute hematogenous osteomyelitis • Chronic osteomyelitis
- 3. Cierny and Maderdeveloped a classification system for chronic osteomyelitis, based on physiological and anatomical criteria, to determine the stage of infection.
- 4. The Usual organismsis: • Staphylococcus Aureus • Escherichia coli • Streptococcus pyogenes • Proteus and pseudomonas
- 5. The physiological criteriadivided into three classes based on three types of hosts. • Class A hosts have a normal response to infection and surgery. • Class B hosts are compromised and have deficient wound healing capabilities. • Class C When the results of treatment are potentially more damaging than the presenting condition.
- 6. Anatomical criteria consistof 4 types. • Type I, a medullary lesion characterized by endosteal disease. • Type II, superficial osteomyelitis limited to the surface of the bone, and infection is secondary to a coverage defect. • Type III is a localized infection involving a stable, well-demarcated lesion characterized by full-thickness cortical sequestration and cavitation • Type IV is a diffuse osteomyelitic, lesion that creates mechanical instability, either at presentation or after appropriate treatment
- 9. Diagnosis of chronicosteomyelitis based on clinical, laboratory, and imaging studies. The “gold standard” is to obtain a biopsy specimen for histological and microbiological . • Physical examination should focus on the integrity of the skin and soft tissue, determine areas of tenderness, assess bone stability, and evaluate the neurovascular status of the limb.
- 10. Clinical Features The goalof the examination is to localize the area of involvement and to identify any possible source. The patient Presents because: • Pain • Pyrexia • Redness and tenderness • Discharging sinus
- 11. Imaging There is lossdensity of bone and sklerosis of the surrounding bone Some variations: • Loss of trabeculation • Area of osteoporosis • Periosteal thickening • Unnaturallydense fragments
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- 14. CT Scan CT bestfor calcified Structures: • Involucrum • Sekuester • Cloaca CT insensitif for: • Bone Marrow Pathology • Soft tissue Pathology
- 15. MRI Good for activecase • Shows extend of soft tissue Oedema • Show abscesses • Drainable fluid collections • Sensitive for boe marrow pathology
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- 17. • Laboratory studiesgenerally are nonspecific and give no indication of the severity of the infection. Erythrocyte sedimentation rate and C-reactive protein are elevated in most patients, but the white blood cell count is elevated in only 35%
- 18. Treatment • Chronic osteomyelitisgenerally cannot be eradicated without surgical treatment . Bacteria are able to adhere to orthopaedic implants and bone matrix. Some can hide intracellularly. • Surgery for chronic osteomyelitis consists of sequestrectomy and resection of scarred and infected bone and soft tissue.
- 19. • Sequestrectomy andCurettage for Chronic Osteomyelitis • Open Bone Grafting • Polymethylmethacrylate Antibiotic Bead Chains • Closed Suction Drains
- 20. The goal ofsurgery is eradication of the infection by achieving a viable and vascular environment. Radical débridement may be required to achieve this goal. Inadequate débridement may be one reason for a high recurrence rate in chronic osteomyelitis.
- 21. Pathology Acute Osteomyelitis • Inflammation •Suppuration • Necrosis • Reactive new bone formation • Resolution • Healing
- 22. Clinical Features • Pain •Fever • Inflammation • Acute tenderness • Normal X- ray during 10 days