Osteomyelitis

Inflammatory diseases of bone

Definition - sequence of bone pathologic changes caused by infection.
(very rare by other - radiation, drugs, toxic…)
- the infective process may involve soft tissue (abscess), periosteum
(periostitis), cortical or spongy bone including bone marrow
(osteitis - direct spread, osteomyelitis - hematogenous spread).
Causes:- bacteria - Staphylococcus aureus, Streptococcus,
Brucellosis, Tuberculosis, syphilis, leprosy (Hansen`s disease)
- viral - Rubella, Variola (smallpox), HIV
- fungal - Coccidioidomycosis, Cryptococcus, Mycetoma
- parasitic - Ecchinococcus
 Osteomyelitis
Pathogeny
– Staphylococcus aureus
– Hematogenic spreed
– Location in metaphyses
– First radiologic sings - at least 14 – 21 days
after clinical signs
 Osteomyelitis
Pathology - frequent location - metaphysis of long bone
- hyperemia (porosis), edema, abscess, trabecular destruction
- pus under pressure
Evolution - stages: 1. Soft tissue swelling day 1-14
typical 2. Osteoporosis day 15-21
3. Osteolysis in patches hazy limits day 22-40
4. Periostitis (sometimes earlier)
5. Sequestrum (sclerotic nucleus, osteolysis,
sclerotic rim) tendency to fistula.
atypical - Brodie abscess
- hypertrophic (Garre)
- pseudotumoral
 Osteomyelitis
Caracteristics
– Chronic disease
– Monostic
– Affects metaphysis + diaphysis,
- Radiological features:
Bone necrosis
Osteosclerosis
Periostosis – periosteal reaction
Hyperostosis -
 Osteomyelitis
Radiologic evolution
– Initial
Soft tissue swelling – 7-14 days from clinical sings
Osteoporosis – 10 - 21 days
Microlacunar metaphisar osteolisis
Lamelar periosteal reaction – 3 – 6 weeks
 Osteomyelitis
Radiologic evolution
– Healing fase
Bone sechestrum – 4 – 6 weeks
Periosteal reaction
Endostosis
Hyperostosis
 Osteomyelitis
Radiologic evolution

Complications
Septic arthritis
Pathologic fractures
Deformities of the limbs
 Osteomyelitis
Atipic forms :
Brodie absces
Hyperostosing
Pseudotumoral
Panaritia
Osteomyelitis of the skull
Osteomyelitis of the spine
Brodie Absces
involucrum

Chronic osteomyelitis
 TB
Pathology - affects both bone and joint (osteo-articular tuberculosis)
- frequent at youth ages (10-30), hematogenous spread from
pulmonary form,
- radiologic changes after 6-12 months
BONE
1. Osteoporosis in large area
2. Marginal osteolysis (sometimes central - bone cysts, cavern)
3. No periosteal reaction
4. Late - abnormal bone reforming process = osteosclerosis
JOINT
1. Symmetrical or non-symmetrical articulary space narrowing
(destruction of cartilage) - total loss = ankylosis
2. Tickening of the capsule, soft tissue swelling
 Tuberculosis
Pathogeny
Young age, secondary disease, hemathogenic
spread
Location epiphysis + joint
Rx sings at 6 months – 2 years from clinical
simptoms
 Osteo-articular tuberculosis
General characteristics :
Chronica disease
Allways bone and joint envolvement
Affects spongy bone, NO envolvement of dyaphisis
– Rx characteristics :
Intensa and extended osteoporosis
Joint distruction - ankilosis
Bone distruction
 Osteo-articular tuberculosis
Bone changes
Intens + extended osteoporosis
Osteolysis

NO:
– Bone sechestrum
– Periosteal reaction
 Osteo-articular tuberculosis
Joint changes:
narrowing
– uniform
– focal
Complet distruction – ankylosis – bone fussion
Changes of joint axes – subluxation

BONE ANKYLOSIS – ONLY IN

ARTHRITIS, NEVER IN ARTHROSES
 Osteo-articular tuberculosis
Typic Forms
Knee
hip
spine = Pott disease
Initial = osteoporosis + surface vertebral
distruction.
Advanced = vertebral osteolysis + colapse +
disc distruction – ankylosis – angular
kyphosis + paraspinal colection
Vertebral fussion – block
TB Spondilodiscitis
Pott disease
Vertebral block
Differential diag. : congenital block
 Spina
ventosa
 Septic arthritis
bacterial joins infection
agents:
1. Staphylococcus aureus
2. Haemophylus influenzae
3. Streptococcus B hemolitic
4. Neiseria gonoreae
 Septic arthritis

Bone distruction - enzimes produced by

bacteria and leucocytes

Vascular envolvement with compresions

and trombosis
 Septic arthritis

Clinic :
- fever
- joint pain
- functional impotence
- soft tissue sweeling
- lab test: leucocytes, reactive C
protein,VSH 
gonococica
arthritis
staphillococic
arthritis