osteomyelitis
OSTEOMYELITIS
Osteomyelitis is an acute or chronic inflammation of the bone due to an infection resulting from hematogenous spread, contiguous spread from soft tissues and joints to bone, or direct inoculation into bone from surgery or trauma.
The infection is generally due to a single microorganism but polymicrobial infections may also occur.
Staphylococcus aureus is a major cause of infection.
Signs and symptoms include fever; inflammatory findings of erythema, warmth, pain and swelling over the involved area; draining sinus tracts over affected bone; limited movement of affected extremity; pain in the chest, back, abdomen or leg, and tenderness over involved vertebrae in patients with vertebral osteomyelitis; anorexia, vomiting and malaise.

Surgical Intervention

  • Indications include persistent fever, erythema, pain & swelling, bacteremia, abscess or sinus tract formation, presence of necrotic bone, & failure to improve after 48-72 hr of antimicrobial therapy
  • Long-bone osteomyelitis is classified into stages based on the magnitude of infection; these stages may be used to guide the type of surgical intervention needed
    • Stage 1 (medullary) often requires unroofing & intramedullary reaming
    • Stage 2 (superficial) often requires superficial debridement, coverage & possibly ablation
    • Stage 3 (localized) often needs debridement, dead space management, temporary stabilization & bone grafting
    • Stage 4 (diffuse) often needs stabilization through open reduction w/ internal or external fixation in addition to procedures required for Stage 3
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