III.

Pathophysiology of Osteomyelitis
External fixation device
Foley catheter
Cerebral or peripheral IV line
Trauma to long bones
Contagious infection
Direct inoculation
- stab or puncture to long bones
mode of entrance for microorganism
(staphylococcus aureus streptococcus group ! streptococcuc Escherchia coli"
Infection
(presence of microorganism"
Inflammatory and immunologic response
Infection spreads through bone vie puss
formation
Vol#mann$s and %aversion canals edema
Vascular
congestion
pain
Vascular occlusion
!one necrosis and ischemia
Ischemia allo&s necrotic bone to
separate from living bone
formation of se'uestra
se'uestra enlarged spreading to&ard
and breading the cortex
forming subperiosteal abcess
interfered vascular supply
bone dies and become inert
central residual remains as se'uestrum composed of cancellous
or cortical bone or combination
ne& bone is formed and forming an encasement
around the se'uestrum
poc#ets of infection are &alled off in &hich
organism lie dormant for long period
chronic sinuses may form and reach the surface and drain
channels become plugged and remains closed until the
pressure of the puss builds up and causes the sinuses
to reopen and reach the surface through ne& channels
(chronic osteomyelitis)
PATHOPHYSIOLOGY
Infection of the bone starts from the entry of the causative agent ((taphylococcus
aureus )roteus )seudomanas E* Coli"* These microorganisms typically find a culture
site in a hematoma from a recent trauma or in a &ea#ened area such as the site of local
infection and spread directly to bone* The microorganisms lodge into an area &here they
&ill gro& and multiply* They &ill travel to the bone by the bloodstream and may travel to
different parts of the body* This &ill no& cause bone inflammation &hich is the initial
response to infection* +fter , or - days thrombosis of the blood vessels occurs in the
area resulting in ischemia &ith bone necrosis* The lumen of the blood vessels &ill
decrease hence causes increase in the pressure on the affected part* +s the organisms
gro& and form pus &ithin the bone tension builds &ithin the rigid medullary cavity and
under the periosteum and may spread into ad.acent soft tissue and .oints forcing pus
through the haversian canals* /nless the infective process is treated promptly bone
abscess form* The resulting abscess cavity contains dead one tiss!e (se'uestrum" &hich
does not easily li'uefy and drain* It also deprives the bone of its blood supply and
eventually may cause necrosis0 hence it stimulates the periosteum to create a ne& bone
(involucrum" &hich surrounds the se'uestrum*
The se'uestrum detaches and &or#s its &ay out through an abscess or the
sinuses* (eparation of dead tissue from living bone may also occur* This &ill no&
develop a sinus tract &hich could eventually turns to scar*