Osteomyelitis: Difference between revisions

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Image = Ostermyelitis Tibia.jpg |
Image = Ostermyelitis Tibia.jpg |
Caption = Osteomyelitis of the [[tibia]] of a young child. Numerous [[abscess]]es in the bone show as radiolucency. |
Caption = Osteomyelitis of the [[tibia]] of a young child. Numerous [[abscess]]es in the bone show as radiolucency. |
ICD10 = {{ICD10|M|86||m|86}} |
ICD9 = {{ICD9|730}} |
ICDO = |
OMIM = |
DiseasesDB = 9367 |
MedlinePlus = 000437 |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D010019 |
}}
}}
{{Osteomyelitis}}
{{Osteomyelitis}}
{{CMG}}'''; Associate Editor(s)-In-Chief:''' {{CZ}}
{{CMG}}; {{AE}} {{MehdiP}},{{NRM}}


{{SK}} OM


== Presentation ==
==[[Osteomyelitis overview|Overview]]==


Generally, microorganisms may infect bone through one or more of three basic methods: via the [[bloodstream]], contiguously from local areas of infection (as in [[cellulitis]]), or penetrating [[Physical trauma|trauma]], including [[iatrogenic]] causes such as [[joint replacement]]s or internal fixation of [[Bone fracture|fracture]]s or [[endodontic therapy|root-canaled]] teeth.<ref name="Robbins" /> Once the bone is infected, [[leukocyte]]s enter the infected area, and in their attempt to [[phagocytosis|engulf]] the infectious organisms, release [[enzyme]]s that [[Lysis|lyse]] the bone. [[Pus]] spreads into the bone's blood vessels, impairing their flow, and areas of devitalized infected bone, known as ''sequestra'', form the basis of a chronic infection.<ref name="Robbins" /> Often, the body will try to create new bone around the area of [[necrosis]]. The resulting new bone is often called an [[involucrum]].<ref name="Robbins" /> On [[histology|histologic]] examination, these areas of necrotic bone are the basis for distinguishing between ''[[Acute (medicine)|acute]] osteomyelitis'' and ''[[wikt:chronic|chronic]] osteomyelitis''. Osteomyelitis is an infective process which encompasses all of the bone ([[wikt:osseous|osseous]]) components, including the bone marrow. When it is chronic it can lead to bone [[sclerosis]] and deformity.
==[[Osteomyelitis historical perspective|Historical Perspective]]==


In [[infant]]s, the infection can spread to the [[joint]] and cause [[arthritis]]. In children, large subperiosteal abscesses can form because the [[periosteum]] is loosely attached to the surface of the bone.<ref name="Robbins" />
==[[Osteomyelitis classification|Classification]]==


Because of the particulars of their blood supply, the [[tibia]], [[femur]], [[humerus]], [[vertebra]], the [[maxilla]], and the mandibular bodies are especially susceptible to osteomyelitis.<ref>{{cite web
==[[Osteomyelitis pathophysiology|Pathophysiology]]==
| url = http://www.emedicine.com/emerg/topic349.htm
| title = Osteomyelitis
| accessdate = 2007-11-11
| author = King MD, Randall W.
| coauthors = David Johnson, MD, FACEP
| date = 2006-07-13
| work = [[eMedicine]]
| publisher = [[WebMD]]
}}</ref> However, abscesses of any bone may be precipitated by trauma to the affected area. Many infections are caused by ''[[Staphylococcus aureus]]'', a member of the normal [[flora (microbiology)|flora]] found on the [[skin]] and [[mucous membrane]]s.


* Hematogenous long-bone osteomyelitis
==[[Osteomyelitis causes|Causes]]==
:* Abrupt onset of high fever (fever is present in only 50% of neonates with osteomyelitis)
 
:* Fatigue
==[[Osteomyelitis differential diagnosis|Differentiating Osteomyelitis from other Diseases]]==
:* Irritability
 
:* Malaise
==[[Osteomyelitis epidemiology and demographics|Epidemiology and Demographics]]==
:* Restriction of movement (pseudoparalysis of limb in neonates)
 
:* Local edema, erythema, and tenderness
==[[Osteomyelitis risk factors|Risk Factors]]==
* Hematogenous vertebral osteomyelitis
 
:* Insidious onset
==[[Osteomyelitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
:* History of an acute bacteremic episode
:* May be associated with contiguous vascular insufficiency
:* Local edema, erythema, and tenderness
:* Failure of a young child to sit up normally2
* Chronic osteomyelitis
:* Non-healing ulcer
:* Sinus tract drainage
:* Chronic fatigue
:* Malaise


==Diagnosis==
==Diagnosis==


Diagnosis of osteomyelitis is often based on [[radiology|radiologic]] results showing a [[lytic]] center with a ring of [[sclerosis]], though bone cultures are normally required to identify the specific pathogen<ref name="Robbins" />.
 
[[Osteomyelitis history and symptoms|History and Symptoms]] | [[Osteomyelitis physical examination|Physical Examination]] | [[Osteomyelitis laboratory findings|Laboratory Findings]]  | [[Osteomyelitis x ray|X Ray]] | [[Osteomyelitis CT|CT]] | [[Osteomyelitis MRI|MRI]] | [[Osteomyelitis other imaging findings|Other Imaging Findings]] | [[Osteomyelitis other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==


Osteomyelitis often requires prolonged [[antibiotic]] therapy, with a course lasting a matter of weeks or months. A [[PICC line]] or [[central venous catheter]] is often placed for this purpose. Osteomyelitis also may require surgical [[debridement]]. Severe cases may lead to the loss of a limb. Initial first line antibiotic choice is determined by the patient's history and regional differences in common infective organisms.
[[Osteomyelitis medical therapy|Medical Therapy]] | [[Osteomyelitis surgery|Surgery]] | [[Osteomyelitis prevention|Prevention]] | [[Osteomyelitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Osteomyelitis future or investigational therapies|Future or Investigational Therapies]]


Prior to the widespread availability and use of antibiotics, [[maggot|blow fly larvae]] were sometimes [[maggot therapy|deliberately introduced]] to the wounds to feed on the infected material, effectively scouring them clean.
==Case Studies==
<ref>{{cite journal |last=Baer M.D. |first=William S. |year=1931 |title=The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blow Fly) |journal=Journal of Bone and Joint Surgery |volume=13 |pages=438–475 |url=http://www.ejbjs.org/cgi/content/abstract/13/3/438 |accessdate= 2007-11-12}}</ref><ref>{{cite journal
| quotes = yes
| last=McKeever
| first=Duncan Clark
| year=2008|month=June
| title=The classic: maggots in treatment of osteomyelitis: a simple inexpensive method. 1933
| journal=Clin. Orthop. Relat. Res.
| volume=466
| issue=6
| pages=1329–35
| pmid = 18404291
| doi = 10.1007/s11999-008-0240-5
}}</ref>


[[Hyperbaric oxygen therapy]] has been shown to be a useful [[wikt:adjunct|adjunct]] to the treatment of [[wikt:refractory|refractory]] osteomyelitis.<ref>{{cite journal |author=Mader JT, Adams KR, Sutton TE |title=Infectious diseases: pathophysiology and mechanisms of hyperbaric oxygen |journal=J. Hyperbaric Med |volume=2 |issue=3 |pages=133–140 |year=1987 |url=http://archive.rubicon-foundation.org/4339 |accessdate=2008-05-16}}</ref><ref>{{cite journal |author=Kawashima M, Tamura H, Nagayoshi I, Takao K, Yoshida K, Yamaguchi T |title=Hyperbaric oxygen therapy in orthopedic conditions |journal=Undersea Hyperb Med |volume=31 |issue=1 |pages=155–62 |year=2004 |pmid=15233171 |url=http://archive.rubicon-foundation.org/4000 |accessdate=2008-05-16}}</ref> A treatment lasting 42 days is practiced in a number of facilities.<ref>Putland M.D, Michael S., Hyperbaric Medicine, Capital Regional Medical Center, Tallahassee, Florida, personal inquiry June 2008.</ref>
[[Osteomyelitis case study one|Case #1]]


==References==
==Related Chapters==
{{Reflist|2}}
 
==See also==
*[[Brodie abscess]]
*[[Brodie abscess]]
==External Links==
* [http://goldminer.arrs.org/search.php?query=Osteomyelitis Goldminer: Osteomyelitis]
==Additional Resources==
* {{MerckManual|5|54|b}}
* {{Chorus|00298}}


{{Diseases of the musculoskeletal system and connective tissue}}
{{Diseases of the musculoskeletal system and connective tissue}}
[[Category:Orthopedics]]
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Latest revision as of 23:27, 29 July 2020

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Osteomyelitis
Osteomyelitis of the tibia of a young child. Numerous abscesses in the bone show as radiolucency.

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