5.2. Bone and Soft Tissue Infection - Chronic Osteomyelitis Flashcards
What can precipitate Chronic Osteomyelitis?
- Acute Osteomyelitis
- Repeated breakdown of “Healed” Wounds
- It may start “De Novo”:
- a) Following an Operation
- b) Following Open Surgery
- c) Due to immunocompromisation (Diabetics, Elderly, Immunosuppressed etc.)
What is the Definition of Chronic Osteomyelitis?
A Chronically Discharging Sinus, (Fixed to the Underlying Bone) containing the Sequestrum (dead bone tissue due to infection).
This is surrounded by infected Granulation Tissue and Involucrum (Layer of New Bone Growth)
What are the common causative Organisms of Chronic Osteomyelitis?
- Staph. Aureus
- E. Coli
- Strep. Pyogenes
- Proteus
Note - this are often a mixed infection
What is the Pathology of Chronic Osteomyelitis?
- Due to an insult, there is a Cavity (possibly a Sinus) within the bone which becomes infected
- An Abscess is formed, due to the infection
- This bone regeneration, forms an Involucrum (Layer of New Bone Growth) and a causes a Cloacae (An opening which allows drainage of purulent and necrotic material)
What is the treatment of Chronic Osteomyelitis?
- Long term Antibiotics (Local or Systemic)
- Surgical Eradication of the Bone Infection
- Treat the Soft-Tissue problems
- Deformity Correction
- Massive Reconstruction
- Amputation
What Local Antibiotics would be given in Chronic Osteomyelitis?
Gentamicin Cement / Beads / Collatamp
What are the Complications of Chronic Osteomyelitis?
- Chronically Discharging Sinus + Flare ups
- Ongiong (Metastatic) Infection (Abscesses)
- Pathological Fracture
- Epithelioma
- Growth Disturbance / Deformities
- Amyloidosis
- Squamous Cell Carcinoma
What was Chronic Osteomyelitis likened to be Klemm in 1996?
Chronic Osteomyelitis is a time bomb which ticks for the patient’s lifetime
