Surgical Infammation.Osteomyelitis. 1. Definition is an inflammation of the bone marrow and adjacent bone. 2.

Types of osteomielitis are Acute hematogenous osteomyelitis and Acute posttraumatic osteomyelitis : 2.1. Acute hematogenous osteomyelitis: in which microorganisms migrate through the bloodstream from a remote soft-tissue infection.The most often cause is infection with Streptococus pyogenis (90% of cases); Acute hematogenous osteomyelitis is developed in the bone which is the locus minoris resitentae and it could heal or progress to chronic infection. 2.2. Acute posttraumatic osteomyelitis is an osteomyelitis associated with open wounds :-in which microorganisms invade bone directly through an open wound; Acute hematogenous osteomyelitis 1. is developed secondary. The migroorganisms migrate through the blood from a primary site of infection which could be furuncle, carbuncle, sore throat, dental infection, abscess, phlegmon, etc.; 2. Pathogenesis : 2.1. Microorganisms migrate to bone through bloodstream and lodge in the methaphysis, which has greatest blood supply and slow blood stream; 2.3. The typical location is Femur which is affected in 70-80% of cases; 2.4. The bacteria provoke (a)inflammation , (b)suppuration , (c)bone erosion in the methaphysis (d)spreading infection into the medullary cavity involving the marrow (e)medullary hypertension (f)spreading of pus through the haversian canals and then forming of (g)subperiostal abscess; N.B.! All these changes are reversible so the healing is possible. 2.5. If not healed the process, the further evolution of ostemyelitis is as follows: (a) the compression on blood vessels in the haversian canals leads to bone necrosis and sequestrum (forming of a piece of dead bone); (b) After that the infection perforates the periosteum and forms a soft- tissue infection phlegmon which progress to fistule with purulent secretion; (c) If the infection spreads to the epiphysis , it cause an acute arthritis; (d) Then bacteria reenter the bloodstream cause septicemia and new foci of infection. The fistule and purulent secretion are typical for chronic osteomyelitis! 3. Clinical signs of acute hematogenous osteomyelitis: 3.1.The acute hematogenous osteomyelitis affects children,(10-14 years old), most often boys. 3.2. The onset is 2 to 10 days after the primary infection; 3.3. The general signs depends on bacterial virulence and Antibiotics and includes: - loss of appetite, getting weaker, high temperature, headache, nausea, vomitting, increased pulse rate; - signs of severe septicemia may be present!; - One of the most dangerous complications are toxic myocarditis and pericarditis. 3.4. Local signs are : - sudden bone pain, of function, and physical signs of inflammation which are late symptoms! The welllocalized tenderness is the earliest symptom. The symptom of fluctuation is observed in the case of subperiostal abscess or soft-tissue involvment 4. Diagnosis of acute hematogenous osteomyelitis: The doctor must make the diagnosis clinically!X-rays disclose periosteal new bone after 8-10 days! - this is the result of subperiosteal and endosteal new bone formation as a defencive reaction; - its a late sign!The diagnosis should be established while the infection is confined in the methaphysis! 5.The Treatment of acute hematogenous osteomyelitis includes: 5.1. General supportive measures:infusional therapy , restore an adequate hemoglobin level,antipyretics and analgetics ,Antibiotic treatment for 4 to 6 weeks ,If an abscess is formed, the surgical treatment is indicated , Immobilization to prevent a pathologic fracture. Chronic osteomyelitis

1.The pathology includes: - unresorbed sequestrum; - unobliterated cavities; - and forming of sclerotic bone arround them; 2. Clinical course could be: - intermittent acute exacerbations; - chronic fistules with purulent secretion; - a focus of hematogenous infections; - or epidermoid carcinoma; 3. Treatment includes : - antibiotics; - surgery. Osteomyelitis associated with open wounds 1.is an direct infection from an open wound or fracture; 2. Pathology includes: (a) early forming of fistule which is a communication between the bone and the skin; (b) Initially the periosteum and the compact bone are affected the process is called osteoperiostitis; (c)And later , the spongy bone and the marrow is affected, a process which is called osteomyelitis; 3. The clinical signs are: 3.1. Those of a fracture; 3.2. and Those of an infection; 4. The diagnosis is easy; 5. The Treatment includes: 5.1. Surgical reposition and immobilization of the fractured bone; 5.2. and Antibiotics treatment.