Академический Документы
Профессиональный Документы
Культура Документы
Infection extends
Medullary cavity Under the periosteum Adjacent soft tissues & joints
Sequestrum (dead bone tissue) does not easily liquefy and drain and abscess
cavity does not collapse and heal
CHRONIC OSTEOMYELITIS
(Healing can still happen however, infected sequestrum remains)
Sequestrum (dead bone tissue)
surrounded by pus and is difficult to reach by blood borne antibiotics and WBCs
can enlarge and serve as sites for microbial growth
can be removed through sequestrectomy
ASSESSMENT
Acute osteomyelitis
Infection lasts usually less than a month
Systemic signs: fever, night sweats, chills, restlessness, nausea, and malaise (body
weakness)
Local signs: swelling and constant bone pain unrelieved by rest and worsens w/
activity
Diagnostic findings:
Xray: Tissue edema
CBC: Elevated leukocyte levels and elevated ESR, normal Hgb (no anemia)
Chronic osteomyelitis
A persistent problem as a result of inadequate treatment or process of exacerbation
& remission
Over time, scar tissue forms and this becomes an ideal site for microorganism
growth
Presents with non-healing ulcer w/ sinus tract that intermittently drains pus
Bone infection that lasts longer than a month / fails to initial antibiotic therapy
Diagnostic findings:
X-ray: large, irregular cavities, raised periosteum, sequestra (dead bone tissue)
present
CBC: ESR & WBC levels are normal, low Hgb (anemia)
PREVENTION
Elective orthopedic surgery should be postponed if the patient has a current
infection (like UTI, sore throat) or a recent history of infection
During orthopedic surgery, careful attention is paid to the surgical environment
to decrease direct bone contamination
Prophylactic antibiotics administered to achieve adequate tissue levels at the
time of surgery and for 24 hours after surgery
Urinary catheters and drains are removed as soon as possible to decrease the
incidence of hematogenous spread of infection
Aseptic postoperative wound care
MANAGEMENT
Acute osteomyelitis
Hydration, diet high in vitamins and CHON
IV antibiotics (4 weeks to 3 mos.) as long as bone ischemia has not yet occurred
o penicillin, nafcillin, neomycin, cephalexin, cefazolin, gentamicin
Surgical debridement & decompression
If not yet better in 2 days, affected areas should be exposed and drilled to release
pus
Immobilization to decrease discomfort and prevent pathologic fracture
Chronic osteomyelitis
Oral antibiotic therapy (Ciprofloxacin) for 6-8 weeks or after IV therapy is started
Hydration and diet (rich in CHON and vitamins)
Sequestrectomy (removal of dead bone tissue)
Saucerization (surgical excavation of tissue to form a shallow depression to facilitate
drainage from infected areas of a wound)
Closed suction irrigation to remove debris
Correct anemia (diet with green, leafy veggies, red meat, iron supplements)
Bone grafting to remove dead bone and replace it with healthy, viable, vascularized
bone; cancellous bone may be used