Osteomyelitis - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Musculoskeletal System.

Osteomyelitis - is purulent infection of the bone (osteitis), the surrounding bone periosteum (periostitis) and bone marrow (myelitis).For the first time caused osteomyelitis called acute.In the case of long-term course of the disease with periods of exacerbation and remission talk about the development of chronic osteomyelitis.

reasons osteomyelitis

Osteomyelitis is caused by bacteria getting into the bone, the periosteum or bone marrow.

bone infection can occur endogenous (internal) means, when bacteria get into the bone tissue with the blood flow through the blood vessels.This is called hematogenous osteomyelitis (translated from Greek - born from the blood).Acute hematogenous osteomyelitis is more common in breast, childhood and adolescence, adults suffer from it often.

purulent inflammation of the bones can occur when the penetration of micro-organisms from the environment - it is an exogenous osteomyelitis.An example of an exogenous osteomyelitis is a bone infection, which developed as a re

sult of an open fracture, gunshot wound or trauma after surgery (also referred to as post-traumatic osteomyelitis).Another kind of exogenous osteomyelitis is pin osteomyelitis arising in the transition of a purulent inflammation of the bone with the surrounding soft tissues.

main pathogens of osteomyelitis is staphylococci and streptococci.In the case of post-traumatic osteomyelitis often find multiple microorganisms commonly found Pseudomonas aeruginosa.

Acute hematogenous osteomyelitis occurs after a previous infection such as tonsillitis (angina), middle ear infection, abscess teeth, felon, boil and furunculosis, pyoderma (pustular skin diseases), omphalitis (inflammation of the umbilical ring), or after infectious diseases - measles,scarlet fever, pneumonia and others.

Posttraumatic osteomyelitis occurs after massive contaminated soft tissue injuries, open fractures, gunshot wounds after surgical treatment of closed fractures with metal osteosynthesis (bone integrity of the restoration metal plates, needles, screws).

contact osteomyelitis occurs when passing the infection to the bone from the surrounding soft tissue in the presence of purulent lesions (abscess, cellulitis).

Contribute to the development of osteomyelitis following states:

• alcohol abuse, smoking, use of intravenous drugs;
• atherosclerosis;
• varicose veins and chronic venous insufficiency;
• diabetes;
• frequent infections (3-4 times a year), indicating the presence of failure of the immune system;
• impaired function of the kidneys and liver;
• cancers (tumors);
• transferred splenectomy (removal of the spleen);
• elderly age;
• low weight, poor nutrition.

Symptoms of osteomyelitis

diagnosis of acute osteomyelitis in the early stages is difficult.

can identify general and local symptoms.The overall picture of the disease, due to the presence of bacteria in blood (bacteremia), as follows: chills appears after a short period of malaise, temperature rises from 37.5 ° C to 40 ° C, the pulse rate increases (higher than 90 beats per minute).At this stage of osteomyelitis can be taken as usual acute respiratory infections (such as flu).

on 2 - 3 day there are local signs of illness in the form of local pain over the affected areas, restrictions on mobility and swelling of the soft tissue segment limbs, skin redness.The most commonly affected bones of the lower extremities (femoral and tibial).Because the bones of the upper limb often affects the shoulder, then the radius and ulna.Rarely in the process involves the bones of hands and feet, as well as the ribs, spine, collarbone, pelvis, scapula.

When exogenous acute osteomyelitis to the fore the local symptoms of the disease: the presence of purulent wounds, trauma and strain contours limbs, redness and increased skin temperature, swelling and tenderness of the soft tissue to the touch, pain when moving the affected area of ​​the body.Common symptoms are less severe and usually go by the wayside.

When such symptoms of osteomyelitis can take abscess (delimited accumulation of pus in the soft tissues), phlegmon (purulent infection common in the soft tissues), erysipelas, post-traumatic hematoma (localized accumulation of blood).These states also require a medical emergency.

In chronic course of the disease to the above symptoms are added to the previously transferred osteomyelitis, and the presence of sinus tracts (round sores on the skin of a small diameter, which comes from the discharge of pus).

first aid for suspected osteomyelitis

Posttraumatic osteomyelitis develops over time (1 - 2 weeks) after the injury, so it is important to treat the wound and seek medical advice promptly.If you have received an extensive injury in violation of the integrity of the skin, then the resulting wound should be washed with soap and water and 0.05% chlorhexidine bigluconate to mechanically remove microorganisms.The skin around the wound should be treated with a solution of brilliant green, put on the wound sterile cloth (sold in the pharmacy).Cloth may be impregnated with a solution of 3% hydrogen peroxide to stop bleeding.The limb should be immobilized.You can make ice.Next, you need to contact the emergency room, where you look on the doctor-traumatologist.

treatment of osteomyelitis arising after fractures and osteosynthesis operations involved in trauma surgeons.In other cases (hematogenous osteomyelitis, osteomyelitis pin) should seek the help of a surgeon on duty in a hospital surgical clinic or surgeon.

Often in the case of osteomyelitis patients fall into the non-core branches, in particular, in the infectious department or therapeutic.However, after the onset of bone lesion symptoms they are transferred to the surgical ward.

survey in the hospital with suspected osteomyelitis

will pass the next inspection is necessary for the diagnosis of osteomyelitis.Pass a general analysis of blood and urine tests, blood glucose levels (to detect diabetes).If possible, you need to donate blood for C-reactive protein, which is a sensitive indicator of the presence of inflammation.

If you have an open wound or pus fistulous perform seeding purulent discharge from them in order to identify the pathogen and its sensitivity to antibiotics.

For visual confirmation of the presence of osteomyelitis perform X-rays of the affected area of ​​the body.However, it should be remembered that the X-ray picture of the disease for 2 weeks behind the clinical, so in the case of acute osteomyelitis of the obvious changes in the beginning of the disease may not be.

The figure shows a typical X-ray pattern of osteomyelitis - a cavity in the bone, pathologic fracture.

more sensitive method of diagnosis is a CT scan, which allows to consider bone defects in more detail.Features CT exceeds the magnetic resonance imaging.The latter allows you to differentiate soft tissue disease from the affected bone, determine the extent of non-viable tissue.Therefore, when choosing between a computer and magnetic resonance tomography should prefer the latter.

possible to perform ultrasound.It reveals the accumulation of pus in the soft tissues, the presence and extent of sinus tracts, changes in the periosteum, and to assess blood flow to the limbs.

most modern way to diagnose osteomyelitis - radionuclide diagnosis.The method is based on the use of radioactive pharmaceuticals that specifically accumulate in inflammation, which allows to determine the presence of the early stage of bone fracture.Unfortunately, it is expensive research, which requires high-tech equipment and special areas, so it is available only in major medical centers.

treatment of osteomyelitis

osteomyelitis treatment systems, is possible only in a hospital or in trauma surgery, includes conservative and surgical measures.

conservative methods of treatment include:

• antibacterial antibiotic therapy is a broad-spectrum - typically 2 -3 prescribed drug (ceftriaxone, lincomycin, gentamicin) for a long time (3 - 4 weeks), replacing them with drugs from other groups (for example, ciprofloxacin, abaktal etc.).;
• detoxification therapy (intravenous saline solutions and plasmapheresis, the UV and laser irradiation of blood treatments - cleansing toxins from the blood plasma);
• immunotropic therapy - the use of pharmaceuticals to increase the activity of the immune system (polyoxidonium);
• the appointment of probiotics - drugs that normalize the intestinal microflora.Due to the massive antibiotic therapy develop goiter.For its correction prescribed lineks, bifiform;
• the appointment of drugs that improve blood circulation (pentoxifylline, trental);
• topical treatment of wounds - dressings with antiseptic ointments (levomekol, Levosin, dioksidinovaya 5% ointment) and proteolytic enzymes (trypsin, chymotrypsin), helps to cleanse and heal wounds.

Surgical treatment of osteomyelitis is the rehabilitation of a purulent focus (opening and drainage of purulent cavities), seizures removal - Lots unsustainable bone and performing recovery operations.Implementation of the latest must be due to the formation of skin and bone defects.By reducing operations they include closing defects with local tissues, bone filling of various preparations and execution of osteosynthesis (eg Ilizarov).

osteosynthesis by Ilizarov

no restrictions on diet after surgery.It should be a balanced diet, rich in vitamins and proteins.The amount of physical activity should be established with the doctor individually.It is desirable to give up drinking alcohol, smoking - they slow down the healing process.In the presence of diabetes must control their blood sugar increase if it is possible relapse.In the postoperative period, and after discharge from the hospital is required physiotherapy and physiotherapy (electrophoresis, phonophoresis, magnetic).

Possible complications osteomyelitis osteomyelitis

Complications can be local and general.

Local complications include:

• abscess and soft tissue abscess - collection of pus and purulent soaking the affected bone surrounding soft tissues;
• suppurative arthritis - a purulent inflammation of the joint, which is located near the focus of osteomyelitis;
• spontaneous fractures - occur at the slightest load due to loss of bone strength;
• contracture - a violation of the mobility due to the formation of scars in the muscles surrounding the purulent center;
• ankylosis - loss of mobility in the affected joints purulent arthritis;
• the development of malignant tumors.

For general complications include:

• septicemia - blood poisoning;
• secondary anemia - anemia develops due to bone marrow suppression against chronic inflammation;
• amyloidosis - an autoimmune disease that affects primarily the kidneys, it is difficult to treat.

Prevention of complications of osteomyelitis

incidence of complications and the probability of a transition in the chronic stage of osteomyelitis depends on the reference to the doctor time.That is why it is so important to see a specialist at the first sign of the disease.Do not self-medicate: in the presence of purulent focus in the bone or soft tissues is necessary to drain the pus (the operation).As long as this is not done, even using modern antibiotics would be ineffective.

As Arthur Schopenhauer: "Health before outweigh all the other good things of life that is truly healthy beggar happier ailing King."So take care of your health.It is better to overestimate the severity of your symptoms, rather than later, seek medical attention.

Surgeon Thews DS