Osteomyelitis: symptoms and treatment

Osteomyelitis

OsteomyelitisIs a purulent infection that affects bone tissue (ostitis), the bone surrounding the periosteum (periostitis) and bone marrow (myelitis).

The first appearance of osteomyelitis is called acute.

In the case of a prolonged course of the disease with periods of exacerbation and remission, they speak of the development of chronic osteomyelitis.

Causes of osteomyelitis

Osteomyelitis develops as a result of the ingress of bacteria into bone tissue, periosteum or bone marrow.

Infection of the bone can occur in an endogenous (internal) way when bacteria enter the bone tissue with blood flow through the blood vessels.

Such osteomyelitis is commonly called hematogenous (in translation from the Greek language - originated from the blood).

Purulent inflammation of the bones can occur with the penetration of microorganisms from the environment - this is exogenous osteomyelitis.

An example of exogenous osteomyelitis is a bone infection that develops as a result of an open fracture, gunshot wound or after trauma surgery (also called post-traumatic osteomyelitis).

Another type of exogenous osteomyelitis is contact osteomyelitis, which occurs when purulent inflammation passes to the bone from surrounding soft tissues.

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The main causative agents of hematogenous osteomyelitis are staphylococci and streptococci. In the case of posttraumatic osteomyelitis, more than one microorganism is found at the same time, a Pseudomonas aeruginosa often occurs.

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Acute hematogenous osteomyelitis occurs after an infection such as tonsillitis (tonsillitis), middle ear inflammation, teeth suppuration, panaricium, furuncle and furunculosis, pyoderma (pustular skin diseases), omphalitis (inflammation of the umbilical ring), or after infectious diseases - measles, scarlet fever, pneumonia and others.

Post-traumatic osteomyelitis occurs after massive contaminated injuries of soft tissues, open fractures, gunshot wounds, after surgical treatment of closed fractures with the use of metalloesteosynthesis (restoration of bone integrity by metal plates, knitting needles, screws).

Contact osteomyelitis occurs when the infection passes to the bone from the surrounding soft tissues in the presence of their purulent lesions (abscess, phlegmon).

The following conditions contribute to the development of osteomyelitis:

• alcohol abuse, smoking, intravenous drug use • atherosclerosis of vessels; • Varicose and chronic venous insufficiency, • diabetes mellitus, • frequent infections (3-4 times a year), indicating a lack of immune system • impaired renal and hepatic function • malignant diseases (tumors) • transferred splenectomy (removal of the spleen) • elderly and senile age;

• Low body weight, poor nutrition.

Symptoms of osteomyelitis

Diagnosis of acute hematogenous osteomyelitis in early stages is difficult.

You can identify common and local symptoms of the disease.

The overall picture of the disease, due to the presence of bacteria in the blood (bacteremia), is as follows: after a short period of malaise, chills appear, the temperature rises from 3 ° C to 40 ° C, the pulse rate increases (above 90 beats in minute). At this stage, osteomyelitis can be considered a normal acute respiratory infection (eg, influenza).

On the 2nd - 3rd day of the disease, local signs appear in the form of local pain over the affected area, restriction of mobility and edema of the soft tissues of the extremity segment, redness of the skin.

The bones of the lower extremities are most often affected (femoral and tibial). Of the bones of the upper limb, the shoulder, then the ray and the ulnar are more often affected.

With exogenous acute osteomyelitis, the local signs of the disease come to the fore: the presence of a purulent wound, the transferred trauma and deformation contours of the limb, redness and increase in skin temperature, swelling and tenderness of soft tissues to the touch, pain when moving in the affected area body. Common symptoms are less pronounced and usually go to the background.

With such symptoms for osteomyelitis, you can take an abscess (a limited accumulation of pus in soft tissues), phlegmon (a common purulent infection in soft tissues), erysipelas, posttraumatic hematoma (local congestion blood). These conditions also require urgent medical attention.

In the chronic course of the disease, the previously transferred osteomyelitis and the presence of fistulous strokes (round purulent wounds of small diameter on the skin from which the purulent separable).

First aid for suspected osteomyelitis

Post-traumatic osteomyelitis develops after a time (1 - 2 weeks) after getting injured, so it is important to properly treat the wound and contact the doctor in a timely manner.

If you have received extensive trauma with a breach of the integrity of the skin, then the wound should be washed with a soap solution and, 5% chlorhexidine bigluconate solution in order to mechanically remove microorganisms.

The skin around the wound should be treated with a solution of brilliant green, put a sterile napkin on the wound (sold at the pharmacy). The napkin can be impregnated with a 3% hydrogen peroxide solution to stop bleeding. The limb should be immobilized.

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You can attach ice. Then you need to go to the emergency room, where you will be examined by a trauma doctor.

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Treatment of osteomyelitis, which arose after fractures, as well as operations of metalloesteosynthesis, are performed by trauma doctors.

In other cases (hematogenous osteomyelitis, contact osteomyelitis), you should seek the help of a surgeon in the on-duty surgical hospital or a surgeon in a polyclinic.

Often in the case of hematogenous osteomyelitis, patients enter non-core units, in particular, into the infectious or therapeutic department. However, after the manifestation of the symptoms of damage to the bone, they are transferred to the surgical department.

Hospital examination for suspected osteomyelitis

For the diagnosis of osteomyelitis will need to undergo the following examination.

To pass the general analysis of a blood and urine, the analysis of a blood on level of a glucose (for that to reveal a diabetes).

If possible, you need to donate blood to C-reactive protein, which is a sensitive indicator of inflammation.

In the presence of an open purulent wound or fistulous course, a purulent discharge is sown from them to determine the pathogen and its sensitivity to antibiotics.

For visual confirmation of the presence of osteomyelitis, X-rays of the affected area of ​​the body are performed. However, it should be remembered that the x-ray picture of the disease is 2 weeks behind the clinical one, therefore, in case of acute osteomyelitis, there can be no obvious changes in the onset of the disease.

The figure shows a typical x-ray picture of osteomyelitis - a cavity in the bone, a pathological fracture.

A more sensitive diagnostic method is computed tomography, which allows a more detailed examination of bone tissue defects.

Therefore, when choosing between computer and magnetic resonance imaging, the latter should be preferred.

It is possible to perform ultrasound. It allows to identify the accumulation of pus in soft tissues, the presence and extent of fistulous passages, changes in the periosteum, and also assess the blood supply to the limb.

The most modern way of diagnosing osteomyelitis is radionuclide diagnostics.

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The method is based on the use of radioactive pharmaceuticals, which specifically accumulate in the inflammatory focus, which allows early detection of the presence of bone tissue destruction.

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Unfortunately, this is an expensive study that requires high-tech equipment and a special room, so it is only available in large medical centers.

Treatment of osteomyelitis

Treatment of osteomyelitis is complex, it is possible only in a hospital in a traumatological or surgical department, it includes conservative and surgical measures.

The conservative methods of treatment include:

• Antibiotic therapy with broad-spectrum antibiotics - Usually prescribe 2 -3 drugs (ceftriaxone, lincomycin, gentamicin) for a long time (3 to 4 weeks), replacing them with drugs from other groups (eg, ciprofloxacin, abaktal and others.

) • detoxification therapy (intravenous saline solutions and plasmapheresis, procedures for ultraviolet and laser irradiation of blood - purification of blood plasma from toxins) • immunotropic therapy - the use of pharmaceuticals that increase the activity of the immune system (polyoxidonium) • the administration of probiotics - drugs that normalize the microflora intestines. Due to massive antibacterial therapy, dysbacteriosis develops. For its correction, appoint a linex, bifiform; • administration of drugs that improve microcirculation (pentoxifylline, trental);

• local treatment of the wound - dressings with antiseptic ointments (levomecol, levosin, 5% dioxidine ointment) and proteolytic enzymes (trypsin, chymotrypsin), which promote purification and healing wounds.

Surgical treatment of osteomyelitis consists in the sanation of the purulent focus (opening and draining of purulent cavities), removal of sequesters - areas of non-viable bone tissue and performing regenerative operations.

Implementation of the latter is necessary due to the formation of defects in the skin and bone tissue.

Restorative operations include closure of defects by local tissues, bone filling with various preparations and osteosynthesis (for example, Ilizarov apparatus).

Osteosynthesis with Ilizarov's apparatus

In the presence of diabetes, blood sugar levels should be monitored, if it increases, a relapse of the disease is possible.

In the postoperative period and after discharge from the hospital, therapeutic physical therapy and physiotherapy (electrophoresis, phonophoresis, magnetotherapy) are necessary.

Possible complications of osteomyelitis

Complications of osteomyelitis can be local and general.

Local complications include:

• abscess and phlegmon of soft tissues - accumulation of pus and purulent impregnation surrounding the affected bone of soft tissues;
• purulent arthritis - purulent inflammation of the joint, located next to the osteomyelitis focus, • spontaneous fractures - occur at the slightest load due to loss of bone • contractures - impaired mobility due to the formation of scars in the muscles surrounding the purulent focus • ankylosis - loss of mobility in those affected by purulent arthritis joints;

• development of malignant tumors.

General complications include:

• sepsis - infection of blood;
• secondary anemia - anemia, develops due to the oppression of hemopoiesis against a background of chronic inflammation;
• Amyloidosis - an autoimmune disease that primarily affects the kidneys, is difficult to treat.

Prevention of complications of osteomyelitis

The incidence of complications and the likelihood of the transition of osteomyelitis to the chronic stage directly depends on the time of going to the doctor. That is why it is so important to consult a specialist at the first signs of the disease.

Do not self-medicate: in the presence of a purulent focus in the bone or soft tissues, it is necessary to give an outflow of pus (perform the operation).

Until this is done, even the use of modern antibiotics will be ineffective.

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As Arthur Schopenhauer said: "Health before that outweighs all other benefits of life, that a truly healthy beggar is happier than a sick king." Therefore, take care of your health. It is better to overestimate the severity of your symptoms than it is too late to seek medical help.

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Surgeon-physician Tevs DS

A source: http://www.medicalj.ru/diseases/orthopedics/853-osteomielit

Symptoms and treatment of osteomyelitis

Inflammation affects all the constituent bones - hard parts and bone marrow, which, as the pathology develops, increases in volume, swells.

As a result, the bone marrow is squeezed by a hard tissue, as a result, blood vessels contract and blood flow stops in the pathological focus.

Often the disease spreads to surrounding soft tissues - the causative agent affects the cells, causing suppuration.

Often pathology is diagnosed in children, more inherent in boys.

Characterized by a rapid transition to a systemic purulent infection (sepsis), which in 36% of cases ends in a fatal outcome.

When developing in an adult, the disease is complicated by pathological fractures, the formation of false joints, the violation of limb functions.

Causes of the disease

The onset of inflammation in the bone marrow is provoked by the infiltration of an infectious agent into it. Microbes attack the bone through vessels, surrounding tissues or deep trauma. Causes of occurrence:

• infectious lesions surrounding soft tissue bone - phlegmon with clear localization, encapsulated cysts after rupture, bacterial inflammation of muscles;
• complications after operations - joint replacement and osteosynthesis;
• hematogenous path: the infection penetrates the bone marrow through the bloodstream - any infectious focus can become the cause of osteomyelitis (for example, chronic inflammation of the kidneys, tonsillitis, furunculosis);
• damage to bones - gunshot and cut wounds, fractures with a rupture of soft tissues and so on.

The presence of an obvious cause does not necessarily mean the development of osteomyelitis, since provoking factors must "work".

1. Not cured or chronic infection. With improper therapy, microbes develop resistance to drugs, then treatment of osteomyelitis with antibiotics will be ineffective.
2. Weakened immunity. This can lead to any disease, a psychoemotional breakdown, a common cold. Problems arise and against the background of long-term use of glucocorticosteroids, with diabetes, systemic diseases of connective tissue, oncology.
3. Small age of patients - children under 5 years.

Classification of pathology, photo

Depending on the cause of development, osteomyelitis types are distinguished:

• hematogenous - an infectious agent penetrates the bone marrow through the bloodstream without open bone injuries;
• Post-traumatic - occurs due to unfinished antibacterial treatment of fractures;
• Gunshot - develops with appropriate injuries;
• Postoperative - can be a postoperative complication - fastening the bone with screws, plates and other structures.

Depending on the rate of development and the duration of the symptoms, osteomyelitis is distinguished:

• acute - develops within 2 weeks, more often in children;
• subacute - proceeds within a month;
• chronic - the clinical picture remains unchanged for more than 30 days, only one bone is affected, a high probability of the appearance of the fistula;
• chronic multi-focal - the symptomatology persists for more than a month, diagnoses multiple foci of inflammation.

Before clarifying the etiology, unspecified osteomyelitis is diagnosed. When the diagnosis is confirmed by an instrumental examination, the chronic form is revealed.

Symptoms of different types of osteomyelitis

The clinical picture changes depending on the form of the course of the disease.

Acute hematogenous

It is characterized by a severe course, a rapid increase in symptoms. The hematogenous form of the disease is of 3 kinds.

Toxic (adynamic)

The clinic corresponds to endotoxic shock, it proceeds aggressively and represents a danger to life. Symptoms:

• a sharp drop in blood pressure;
• loss of consciousness, coma;
• critical hyperthermia - increase in temperature to 40-41 ° C;
• shortness of breath, shortness of breath;
• convulsions inherent in children.

The condition leads to heart failure and death. Often, timely and competent resuscitation does not help.

Sometimes doctors detect acute hematogenous toxic osteomyelitis due to complaints of the patient - swelling in the site of the affected bone, hyperemia and skin temperature increase.

Septic-epic

The clinical picture develops immediately after infection enters the blood:

• heat;
• Strong headache;
• hypotension;
• weakness.

Signs are combined with intense pain in the focus of inflammation, severe swelling and redness of tissues. With proper and timely care, survival of patients with a diagnosis is 40-50%, in the absence of treatment, death occurs in 70% of patients.

Local

The mild course of the disease causes a favorable prognosis. For local hematogenous osteomyelitis, there are moderate general symptoms:

• fever;
• increased sweating;
• severe weakness;
• lack of appetite;
• a low-intensity headache.

Nonsteroidal anti-inflammatory drugs, analgesics and antipyretics do not help. When examining the patient, note the swelling, redness of the skin at the site of inflammation.

Subacute osteomyelitis

Subacute osteomyelitis is a transitional period, after which the chronic stage of the disease occurs. Is manifested by symptoms:

• not falling subfebrile body temperature;
• slight weakness;
• mild dull pain in the pathological focus;
• Limited mobility of the joint located next to the affected bone.

Chronic osteomyelitis

The patient's condition is within the normal range, sometimes worried about the discomfort in the place of the defeat of the bone, subfebrile temperature, small swelling. Consequences of pathology:

• purulent fistula - the beginning of the canal in the infected bone, exit to the skin;
• shortening of the affected limb.

For chronic osteomyelitis, radiologic signs are applicable, which in no way affect the overall well-being of the patient - for example, periodically separates parts of diseased bone that have undergone structural destruction, - sequestration.

Osteomyelitis after tooth extraction

Maxillofacial pathology, symptomatology depends on the severity of the flow. In addition to classical signs, one observes:

• impossibility to open your mouth wide;
• severe pain when chewing and swallowing;
• pronounced edema of the face.

Osteomyelitis of the spine

Severe back pain is a major symptom. It is not removed by drugs, physical exercises, physiotherapy, massage and warming. Localized pain occurs in the first hours after the defeat of a specific bone. As the disease progresses, there are:

• increased sensitivity of the skin, touching the spine is impossible - even light touch causes an acute attack of pain;
• increased heart rate;
• a sharp drop in pressure;
• unmotivated weight loss.

Methods of diagnosing osteomyelitis

To confirm the diagnosis, the patient is examined:

• laboratory tests of blood and urine will indicate a rise in the level of leukocytes, the development of acute inflammation;
• Infrared scanning (thermal imager) is used to identify the area of ​​acute pathology;
• puncture of the bone can be a diagnostic or therapeutic procedure, for the diagnosis is carried out the removal of purulent contents from the affected bone;
• X-rays - pictures are taken in two projections, allow to determine the location of the inflammatory focus, the diagnosis can be established on 3-5 days from the lesion.

Computer tomography is more informative than other diagnostic methods. The study helps to determine the localization of pathology, to reveal the vastness of the process. CT is performed for the differentiation of osteomyelitis from other pathologies of bones.

How and what to treat different types of osteomyelitis

Treatment of the early stage of acute osteomyelitis is carried out by a therapeutic method.

Treatment of osteomyelitis medication

The purpose of therapy is the destruction of the infectious agent.

1. Antibiotics - Cefazolin, Co-trimoxazole, Linezolid and others. The drugs are administered individually, based on the results of bacteriological cultures. When treating the hematogenous form of the disease, several means are often combined. The duration of antibiotic therapy is from 20-30 days, with hematogenous form a month and more.
2. Immunomodulators - Amiksin, Timalin and others. The course of treatment is determined individually, the duration of therapy is from 10 days to several months. Immunomodulators are necessary to support and strengthen the immune system, increase the body's resistance to infection.
3. Diuretics - Lasix or Furosemide. Quickly eliminate swelling. Often appointed in the treatment of osteomyelitis after tooth extraction. The treatment plan is determined by the doctor, the patient's condition is taken into account.
4. Crystalloids - Trisol, saline, Normosol and others. Introduce intravenously 5 days for the elimination of symptoms and normalization of the condition.

Treatment of chronic osteomyelitis

Therapy for chronic osteomyelitis is carried out during periods of exacerbation. The scheme of treatment does not differ from that used in acute form of the disease. In the periods of remission, supportive therapy with immunomodulators takes place.

Chronic osteomyelitis is treated at home, but with the permission of a specialist. A slight deterioration in the condition is an occasion for hospitalization.

Often when a bone is deformed, a shortening of the affected leg occurs, fistulas that do not heal for a long time and periodically become filled with purulent exudate appear.

In such cases, raise the issue of conducting an operation.

Surgical treatment of osteomyelitis

Operative intervention is prescribed when:

• intermuscular and periosteal phlegmon;
• suppurative arthritis;
• atypical form of pathology;
• extensive fistula, not amenable to therapeutic treatment;
• frequent and severe relapses.

Operations to remove a purulent focus are almost always performed in dentistry. The procedure is performed under local anesthesia.

The doctor makes a cut of the gum and lower tissues, cleans the affected area of ​​the bone.

Osteomyelitis after tooth extraction is treated by the doctor of maxillofacial surgery, if necessary, a plastic surgeon is involved.

Operations are conducted in two ways.

1. Incision of tissues in the site of the focus to remove pus from muscle fibers, periosteum, tendons. The doctor cuts the soft tissue without opening the bone.
2. Osteoperforation. A hole is made in the bone through which the cavity is sanitized. At the end, a drainage device is fixed, which ensures the outflow of exudate from the source. The operation is more often used for acute osteomyelitis, when it is necessary to urgently remove the focus.

For the treatment of chronic osteomyelitis, the compression-distraction osteosynthesis is performed according to Ilizarov: the affected area of ​​the bone is removed, its ends are connected, the limb axis is fixed with rings and spokes. When the bone begins to fuse, with the help of vertical rods, the rings are gradually moved apart, stretching out the limb.

Features of treatment of osteomyelitis in children

Surgeons prefer to spend sparing operations, allowing to keep functionality of an osteal apparatus. Specialists choose the puncture method, suitable for treating children under 6 years old.

Carrying out the operation in children consists in "piercing" the bone with a special needle, sucking off pus and washing the focus with antibacterial drugs.

In the therapeutic treatment of osteomyelitis, a fixing gypsum is applied to the limb, and the load is removed. So it is possible to prevent the spread of the infection and its penetration into soft tissues.

Diet during treatment

The patient needs a lot of protein, which is contained in chicken and beef liver, dairy products, meat and fish. It is not necessary to confine oneself to such dishes - the work of the intestine may be disrupted. Fiber must necessarily enter the menu - porridge, vegetables and fruits.

Frequent questions from patients

Osteomyelitis is a dangerous disease, can lead to disability or death. It is important to diagnose the disease in a timely manner, correctly conduct treatment and undergo rehabilitation.

Which doctor heals?

If signs of osteomyelitis need to seek help from an orthopedist. In state medical institutions, it is first necessary to visit a surgeon who will give directions to a narrow specialist.

Whether it is possible to cure completely?

Cases of complete recovery of patients with osteomyelitis are not an exception, but rather a frequent occurrence. This is possible with timely diagnosis and competent treatment. Even with the development of the disease in newborns, doctors give favorable predictions.

Is disability given to a child after an osteomyelitis?

You can get disability if the pathology has been in severe form, the bone has deformed, and the patient has lost the ability to lead an active life.

For example, if the lower limb becomes shorter, the child is shown a disability. In other cases, he is released from physical education for 6-12 months.

Is osteomyelitis contagious?

When treated in a hospital, the patient is placed in a general ward. Pathology is not contagious, although it has an infectious etiology. In chronic osteomyelitis patient leads a habitual way of life, but with some restriction of physical exertion.

How many years the patient can live with chronic osteomyelitis?

These are individual indicators, depending on the age of the patient, the extent of the lesion, the quality of the treatment and other.

A source: http://www.infmedserv.ru/stati/simptomy-i-lechenie-osteomielita

Osteomyelitis

Osteomyelitis is an infectious inflammatory disease, in which not only the bone and bone marrow suffers, but the entire body as a whole. To learn to live with such a diagnosis, you need to know all the subtleties of diagnosis, treatment and prevention of this ailment.

Causes of osteomyelitis

Osteomyelitis (Greek.

osteo - "bone myelo - the "brain -itis - "inflammation") - an infectious disease in which the bone marrow and all the constituent elements of the bone are damaged (periosteum, spongy substance, compact substance).

During the purulent necrotic process in the bone tissues, many toxins are released that cause serious intoxication of the whole organism and are accompanied by a high temperature and severe pain syndrome.

The main cause of the development of this disease are bacterial pathogens:

• Staphylococcus aureus,
• epidermal staphylococcus,
• streptococci,
• gram-negative enterobacteria,
• Pseudomonas aeruginosa,
• haemophilus influenzae,
• Mycobacterium tuberculosis (Koch's stick).

Pathogenic microorganisms can enter the body and cause the development of osteomyelitis in several ways:

• exogenous - when the pathogen enters the bone directly in case of trauma, injury, open fracture, purulent inflammation of nearby tissues or in case of surgical intervention;
• endogenous (hematogenous) - with a blood flow in the presence of a foci of chronic infection in the body (tonsillitis, caries).

Depending on the mechanism of origin of osteomyelitis, distinguish:

• hematogenous,
• gunshot,
• postoperative,
• posttraumatic,
• contact.

In most cases, the cause of osteomyelitis is staphylococcus aureus, which is often the cause of tonsillitis, caries or omphalitis in newborns.

Most often, the causative agent of osteomyelitis damages:

• tubular bones of the upper and lower extremities,
• bones of the upper jaw,
• skull bones,
• ribs and spine.

Factors contributing to the development of osteomyelitis:

• fractures of bones,
• joint transplantation,
• renal and hepatic insufficiency,
• diseases that cause weakening of the body's defenses (diabetes, AIDS, chemotherapy, organ transplants),
• avitaminosis,
• frequent changes in the temperature regime,
• addiction,
• diseases of peripheral vessels and nerves.

When bone tissue is damaged by pathogenic microorganisms, leukocytes migrate to inflamed areas, which secrete lysis enzymes that decompose bone.

Pus, spreading through the blood vessels, promotes the rejection of necrotic bone tissue, thereby creating favorable conditions for the growth and reproduction of pathological microflora.

There is an acute purulent inflammation, which can go to the phase of chronic inflammation.

In this case, the inflammatory process develops in the place of fragmented bone fragments, and not in the closed medullary canal. The bone marrow is infected from infected nearby tissues.

Fragments die and become the cause of suppuration and the formation of purulent cavities and fistulas. These pathological processes prevent the formation of normal callus.

Symptoms of osteomyelitis

The clinical picture of osteomyelitis largely depends:

• from the type of pathogen,
• from the site of localization and spread of the inflammatory process,
• on the age and condition of the patient's immune system.

Acute osteomyelitis can have 3 clinical forms:

• septic-piecemic,
• local,
• toxic.

The first symptom of septic-piemic osteomyelitis is fever with body temperature up to 39-400, followed by symptoms of general intoxication (excessive sweating, weakness, irritability, muscle pain, nausea, vomiting, headache pain).

Symptoms of general intoxication are joined by bone pain. It gradually changes its character from aching to bursting, and pain intensification is observed during movements.

There are also changes with proper tissues: redness, local fever, edema, cutaneous-fistulas with purulent discharge.

Almost 48-72 hours after the onset of the disease there is a violation of the acid-base balance of the body (acidosis):

• hyperkalemia,
• hypercalcemia,
• hyponatremia.

There are also changes with the coagulating system of blood: hypercoagulability (increased coagulability) is replaced hypocoagulation (reduced coagulability), followed by the phase of fibrinolysis (cleavage of blood clots and blood clots bunches).

Osteomyelitis is most common in children and the elderly, in men this disease occurs twice as often as in women. In children, hematogenous osteomyelitis is most common, whereas in adults the cause is an infected trauma or surgical intervention.

In toxic osteomyelitis, the disease develops with lightning speed with a clinical picture of acute sepsis. During the first 24 hours, the symptoms of severe intoxication increase and are accompanied by:

• high body temperature,
• meningeal symptoms,
• convulsions and loss of consciousness,
• a critical reduction in blood pressure,
• increasing cardiovascular insufficiency, which often has a lethal outcome.

In this case, there is difficulty in diagnosing osteomyelitis, because the symptoms of general intoxications are increasing, and the appearance of specific signs of the disease is significantly lagging behind in time appearance.

With local osteomyelitis, the symptoms of the inflammatory process localized in soft and bony tissues are predominant, accompanied by a satisfactory or moderate condition of the patient.

In acute posttraumatic and gunshot osteomyelitis, the clinical picture depends on the location inflammatory focus, timely surgical treatment of the wound, immune system status and age patient. The clinical picture grows gradually, 10-14 days can disturb the suppuration of the wound and only after 2 weeks the symptoms of general intoxication grow.

Possible complications of osteomyelitis

If untimely or inadequate treatment, such complications are possible:

• sepsis,
• pleurisy,
• deformities and fractures of bones,
• violation of the structure and function of the joints,
• fistula formation and malignancy,
• the transition of the inflammatory process into a chronic form,
• death.

Diagnosis of osteomyelitis

From the early correct diagnosis and the timely appointment of treatment depends very much, and even the life of the patient. To identify osteomyelitis at an early stage will help laboratory and instrumental methods of diagnosis:

• correctly collected anamnesis of the disease (when the first signs of the disease appeared and with what are connected);
• Electro-radiography is an X-ray method in which an X-ray image is obtained and studied on a charged semiconductor wafer;
• Thermography - the method of recording the infrared radiation of the human body;
• puncture of bone with osteotonometry - examination of tissues from the focus of inflammation, which are taken for analysis with a small needle;
• radionuclide diagnostics - studying the structure of the bone with the help of contrast medium;
• X-ray diagnostics - X-ray diagnostics;
• computer tomography - X-ray diagnostics, which are computer-controlled, scanning the body in a horizontal and vertical position;
• fistulography - X-ray examination of fistula using contrast medium;
• MRI is a computer diagnostic method using powerful magnets that record and process radio wave information, transforming it into images of internal organs and systems;
• Ultrasound is a diagnostic method in which high-frequency waves are used;
• a general analysis of blood and urine - helps to identify inflammatory processes in the body with the help of indicators of hemodynamics.

Treatment of osteomyelitis

It should be noted that osteomyelitis is very difficult to treat. Sometimes the course of antibiotic therapy last 4-5 months. But even after the disappearance of clinical symptoms and improve the patient's condition, a relapse of the disease is possible.

Treatment of osteomyelitis, as well as its diagnosis, should be conducted by an experienced specialist, a surgeon or traumatologist in a hospital. Treatment of this disease should be comprehensive:

• sanation of the focus of inflammation,
• antibiotic therapy,
• anti-inflammatory drugs,
• detoxification therapy,
• activation of the body's defenses, immunostimulation,
• immobilization of the affected part of the body.

The effectiveness of treatment depends primarily on a properly prescribed antibiotic. Antibiotic therapy can last from several weeks to several months and has many side effects.

But the drugs of this group are able to return the patient to a full life.

In particularly severe cases, surgical treatment is indicated, the purpose of which is to clean and sanitize the wound, remove dead tissue and drainage.

With untimely and incorrect treatment, acute osteomyelitis can go on into a chronic form, periodically reminding oneself of relapses in the form of fistulas, ulcers, sequesters, false joints.

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After intensive hospital treatment, the patient is prescribed a course of physiotherapeutic procedures and exercise therapy.

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Therapeutic physical culture is shown for the general toning effect, for restoration of the function of the affected part of the body and stimulation of trophic processes in the tissues. From physiotherapeutic procedures it is shown:

• UHF therapy,
• infrared laser therapy,
• electrophoresis,
• paraffinotherapy,
• ozokeritotherapy,
• high-frequency magnetotherapy.

All these procedures are aimed at restoring the function and nutrition of the damaged part of the body. Equally important in the treatment of osteomyelitis is a healthy lifestyle and a balanced diet. In addition, prescribe vitamins B, C, PP.

For a full recovery recommended sanatorium treatment, which is aimed not only at restoring functions, but also on cleansing the body after prolonged hospital treatment. In the treatment of osteomyelitis, such climacteric and balneal resorts are well recommended:

• Sochi,
• Pyatigorsk,
• Hops,
• Baden Baden,
• Nishka-Banya.

As mentioned above, osteomyelitis requires long-term treatment and careful care. Full recovery is possible, but it depends on many factors:

• age of the patient,
• severity of defeat,
• timely diagnosis and treatment.

Prevention of osteomyelitis

It is possible to speak about effective treatment of osteomyelitis only if within 2-3 years after the first detection of the disease it was possible to avoid relapse.

But, as one of the main commandments of medicine says: "The disease is easier to prevent than to treat later."

To prevent osteomyelitis, you need:

• to lead a healthy and active lifestyle,
• provide a full sleep and rest,
• avoid stress,
• balanced eating,
• strengthen the immune system,
• in time to heal foci of infection (caries, sinusitis),
• with injuries or gunshot wounds, you need to seek medical help in a timely manner,
• with an increase in body temperature and the appearance of other symptoms, you need to go to the hospital, so as not to maim the rest of your life by self-medication.

Osteomyelitis is a serious infectious disease that requires efforts not only from the attending physician, but also from the patient himself. As folk wisdom says: "The salvation of drowning people is the work of the drowning themselves".

To defeat such a serious disease, there is insufficient adequate treatment and efforts on the part of medical staff.

A full and healthy life directly depends on the moral mood and belief in his recovery of the patient.

A source: http://bezboleznej.ru/osteomielit

Osteomyelitis

Osteomyelitis- Inflammation of the bone marrow, which usually affects all elements of the bone (periosteum, spongy and compact substance). According to statistics, osteomyelitis after injuries and surgeries is,% of all diseases of the musculoskeletal system.

More often affects femur and humerus, bones of the lower leg, vertebrae, mandibular joints and upper jaw.

After open fractures of the diaphysis of the tubular bones, posttraumatic osteomyelitis occurs in 1% of cases.

Men suffer from osteomyelitis more often than women, children and the elderly are more likely to be young and middle-aged.

Classification of osteomyelitis

There are nonspecific and specific osteomyelitis.

Nonspecific osteomyelitis is caused by pyogenic bacteria: Staphylococcus aureus (90% of cases), streptococcus, Escherichia coli, less often fungi.

Specific osteomyelitis occurs with tuberculosis of bones and joints, brucellosis, syphilis, etc.

Depending on the way in which microbes penetrate into the bone, distinguish endogenous (hematogenous) and exogenous osteomyelitis.

With hematogenous osteomyelitis, pathogens of purulent infection are entered through the blood from a remote hearth (furuncle, panaritium, abscess, phlegmon, infected wound or abrasion, tonsillitis, sinusitis, carious teeth and so forth).

In exogenous osteomyelitis, the infection penetrates into the bone during injury, surgery, or spreads from surrounding organs and soft tissues.

There are following forms of exogenous osteomyelitis:

• post-traumatic (after open fractures);
• gunshot (after gunshot fractures);
• Postoperative (after carrying out the spokes or operations on the bones);
• contact (in the transition of inflammation from surrounding tissues).

As a rule, osteomyelitis at the beginning is acute. In favorable cases, it ends in recovery, in unfavorable cases it changes into chronic.

In atypical forms of osteomyelitis (Brody's abscess, Ollie's albuminous osteomyelitis, Garre's sclerosing osteomyelitis) and some infectious diseases (syphilis, tuberculosis, etc.)

) the acute phase of inflammation is absent, the process is primarily chronic.

The manifestations of acute osteomyelitis depend on the path of infection, the general condition of the body, the vastness of traumatic damage to the bone and surrounding soft tissues. On radiographs, changes are visible after 2-3 weeks from the onset of the disease.

Hematogenous osteomyelitis

As a rule, it develops in childhood, and one third of patients get sick before the age of 1 year.

Quite rare cases of development of hematogenous osteomyelitis in adults are actually relapses of the disease transferred in childhood.

More often affects the tibia and femur. Multiple lesions of bones are possible.

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From a remote source of inflammation (abscess of soft tissues, phlegmon, infected wound), microbes with blood are carried throughout the body.

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In long tubular bones, especially in their middle part, a wide network of vessels is well developed, in which the blood flow velocity slows down. Infectious agents settle in the spongy substance of the bone.

Under adverse conditions (hypothermia, decreased immunity), microbes begin to multiply intensively, hematogenous osteomyelitis develops. There are three forms of the disease:

Septic-pieemic form. Characterized by acute onset and marked intoxication. Body temperature rises to 39-40 °, accompanied by chills, headache and repeated vomiting.

Possible loss of consciousness, nonsense, convulsions, hemolytic jaundice. The patient's face is pale, the lips and mucous membranes are cyanotic, the skin is dry. The pulse is rapid, the pressure is reduced.

The spleen and liver are enlarged, bronchopneumonia sometimes develops.

On the first or second day of the disease, there appears precisely localized, sharp, boring, bursting or tearing, intensifying at the slightest movement pain in the area of ​​the lesion. Soft tissues of the limb are swollen, the skin is hot, red, tense. When spreading to nearby joints, purulent arthritis develops.

After 1-2 weeks in the center of the lesion formed a focus of fluctuations (fluid in soft tissues). Pus penetrates into the muscles, an intermuscular phlegmon is formed.

If phlegmon can not be opened, it can open itself with the formation of a fistula or progress, leading to the development of paraarticular flegmon, secondary purulent arthritis or sepsis.

Local form. The general condition suffers less, sometimes it remains satisfactory. The signs of local inflammation of bone and soft tissue predominate.

Adynamic (toxic) form. It is rare. Characterized by a lightning start.

Symptoms of bone inflammation are weak, appear late, which makes it difficult to diagnose and perform treatment.

Post-traumatic osteomyelitis

It occurs with open fractures of bones. The development of the disease contributes to the contamination of the wound at the time of injury.

The risk of developing osteomyelitis increases with comminuted fractures, extensive damage to soft tissues, severe accompanying lesions, vascular insufficiency, and decreased immunity.

Post-traumatic osteomyelitis affects all parts of the bone. With linear fractures, the area of ​​inflammation is usually limited to the site of fracture, with splinter fractures, the purulent process is prone to spreading.

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It is accompanied by a hectic fever, marked by intoxication (weakness, weakness, headache, etc.), anemia, leukocytosis, an increase in ESR. The tissues in the fracture region are edematous, hyperemic, sharply painful.

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A large amount of pus is released from the wound.

Gunshot osteomyelitis

It often occurs with extensive damage to bones and soft tissues. The development of osteomyelitis contributes to psychological stress, reduced body resistance and insufficient wound treatment.

Common symptoms are similar to post-traumatic osteomyelitis. Local symptoms with acute gunshot osteomyelitis are often poorly expressed.

Edema of the extremity is moderate, abundant purulent discharge is absent. The development of osteomyelitis is indicated by a change in the wound surface, which becomes dull and covered with a gray bloom.

Despite the presence of a foci of infection, with firing osteomyelitis usually occurs fusion of the bone (except - a significant fragmentation of the bone, a large displacement of the fragments). At the same time purulent foci appear in the bone callus.

Postoperative osteomyelitis

It is a kind of posttraumatic osteomyelitis.

Occurs after operations on osteosynthesis of closed fractures, orthopedic operations, imposition of compression-distraction apparatus or application of skeletal traction (spinal osteomyelitis). As a rule, the development of osteomyelitis is caused by non-observance of asepsis rules or a large traumatic operation.

Contact osteomyelitis

Occurs in purulent processes surrounding the bone of soft tissues.

Especially often the infection spreads from soft tissues to the bone with panaritium, abscesses and phlegmon of the brush, extensive wounds of the scalp.

It is accompanied by an increase in edema, increased pain in the area of ​​damage and the formation of fistula.

Only in a hospital in the department of traumatology. Perform immobilization of the limb. Conduct a massive antibiotic therapy, taking into account the sensitivity of microorganisms.

To reduce intoxication, replenish blood volume and improve local blood circulation, transfuse plasma, hemodez, 10% albumin solution.

In sepsis, extracorporeal hemocorrection methods are used: hemosorption and lymphosorption.

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An obligatory condition for the successful treatment of acute osteomyelitis is the drainage of the purulent focus. In the early stages of the bone, trephine holes are made, followed by washing with solutions of antibiotics and proteolytic enzymes.

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With purulent arthritis, repeated joint puncture is performed to remove pus and administer antibiotics, in some cases, arthrotomy is indicated. When the process spreads to soft tissues, the abscesses formed are opened with subsequent open rinsing.

Chronic osteomyelitis

With small foci of inflammation, comprehensive and timely treatment, mainly in young patients, bone tissue restoration prevails over its destruction.

Foci of necrosis completely replaced by a newly formed bone, recovery comes.

Approximately 4 weeks, with all forms of acute osteomyelitis, sequestration occurs - the formation of a dead bone region surrounded by a modified bone tissue. For 2-3 months, sequesters are finally separated, a cavity is formed at the site of bone destruction and the process becomes chronic.

Symptoms

With the transition of acute osteomyelitis to the chronic condition of the patient improves. The pains decrease, they become aching.

Fistulous passages are formed, which can look like a complex system of canals and reach the surface of the skin far from the site of injury.

Of fistulas, a moderate amount of purulent discharge is released.

During the period of remission, the patient's condition is satisfactory. The pain disappears, separated from the fistulas becomes scarce. Sometimes fistulas close.

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The duration of remission with osteomyelitis varies from several weeks to several tens of years, depending on the general condition and age of the patient, localization of the outbreak, etc.

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The development of relapse is promoted by concomitant diseases, decreased immunity and fistula closure, leading to accumulation of pus in the formed bone cavity.

Relapse of the disease resembles an erased picture of acute osteomyelitis, accompanied by hyperthermia, general intoxication, leukocytosis, increased ESR. The limb becomes painful, hot, blushes and swells.

The patient's condition improves after opening a fistula or opening an abscess.

Complications of chronic osteomyelitis

Chronic osteomyelitis is often complicated by fractures, the formation of false joints, bone deformation, contractures, purulent arthritis, malignancy (malignant tissue degeneration). A constantly existing focus of infection affects the entire body, causing amyloidosis of the kidneys and changes in internal organs. In the period of recurrence and with the weakening of the organism, sepsis is possible.

Diagnosis of chronic osteomyelitis

The diagnosis of chronic osteomyelitis in most cases is not difficult. For confirmation, an MRI, CT or X-ray examination is performed. Fistulography is used to detect fistulous passages and their connection with the osteomyelitic focus.

Treatment of chronic osteomyelitis

The operation is indicated in the presence of osteomyelitis cavities and ulcers, purulent fistula, sequestrants, false joints, frequent relapses with intoxication, severe pain and violation of limb function, malignancy, violation of the activity of other organs and systems due to chronic purulent infection.

Perform necrectomy (sequestrectomy) - removal of sequestrants, granulations, osteomyelitic cavities along with internal walls and excision of fistula with subsequent draining. After the sanitation of the cavities, bone grafting is performed.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/osteomyelitis