Musculoskeletal Disorders

Musculoskeletal Disorders

Osteomyelitis

Osteomyelitis • Severe infection of the • Bone • Bone marrow • Surrounding soft tissue • Caused by a variety of microorganisms • Most common infecting microorganism

Etiology and Pathophysiology • Antibiotics in conjunction with surgical treatments have decreased mortality rate and complications • Infecting microorganisms can invade by • Indirect entry • Direct entry

Direct Entry • Can occur at any age • Open wound where microorganisms can gain entry to body • May also occur in presence of foreign body

Direct Entry • Sequestrum continues to be an infected island of bone, surrounded by pus • Difficult for blood-borne antibiotics or white blood cells (WBCs) to reach sequestrum • Sequestrum can move out of bone and into soft tissue

Direct Entry • Once outside bone • Sequestrum may • Revascularize and then undergo removal by normal immune process • Be surgically removed through debridement of necrotic bone • If necrotic sequestrum is not resolved, it may develop a sinus tract resulting in chronic, purulent cutaneous drainage

Indirect Entry • Frequently affects growing bone in boys <12 years old ---Why??? • Most common sites of indirect entry • Distal femur • Proximal tibia • Humerus • Radius

Indirect Entry • Adults with increased risk • Vascular disorders • Genitourinary and respiratory infections • Spread infection from blood to bone • Vascular-rich bone sites • Pelvis • Tibia • Vertebrae

Development of Osteomyelitis Fig64-1

Clinical ManifestationsAcute Osteomyelitis • Initial infection • Infection of <1 month in duration • Both systemic and local

Clinical ManifestationsAcute Osteomyelitis • Systemic • Local • Constant bone pain that worsens with activity • Swelling, tenderness, warmth at infection site • Restricted movement of affected part • Later signs: drainage from sinus tracts

Chronic – an infection that persists for longer than 1 month Infection that has failed to respond to initial course of antibiotic therapy Systemic signs ______ Signs and Symptoms Constant bone pain Swelling Tenderness Warmth at site Continuous Drainage Clinical Manifestations of Chronic Osteomyelitis

Diagnostic Studies • Bone or soft tissue biopsy • Definitive way to determine causative microorganism • Patient’s blood and/or wound culture • Frequently positive for presence of microorganism • Lab Studies • WBC • Erythrocyte sedimentation rate (ESR)

Radiologic Studies • Radiologic signs • Usually do not appear until 10 days to weeks after start of clinical symptoms • Radionuclide bone scans • Helpful in diagnosis and usually positive in areas of infection • Magnetic resonance imaging (MRI) • Computed tomography (CT) • Help identify extent of infection, including soft tissue involvement

Collaborative CareAcute Osteomyelitis • Patients are often discharged to home care or skilled nursing facility (SNF) with IV antibiotics delivered via

Collaborative CareAcute Osteomyelitis • Vigorous and prolonged intravenous (IV) antibiotic therapy • Treatment of choice for acute osteomyelitis • As long bone ischemia has not occurred • Cultures or bone biopsy should be done if possible • Delaying antibiotic treatment may require surgical debridement and decompression

Collaborative CareAcute Osteomyelitis • Antibiotic therapy may be continued for at home for _ to _ _____ or as long as _ __ _ ______ • Variety of antibiotics may be prescribed • Penicillin, nafcillin (Nafcil) • Neomycin, vancomycin • Cephalexin (Keflex) • Cefazolin (Ancef)

Collaborative Care Chronic Osteomyelitis • Adults with chronic osteomyelitis may be prescribed oral therapy + fluoroquinolone for 6 to 8 weeks instead of IV antibiotics • Oral antibiotics may be given after acute IV therapy to ensure resolution of infection • Monitoring patient’s response

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Musculoskeletal Disorders