Definition of the Disease Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone, myelo- meaning

marrow, and -itis meaning inflammation) simply means an infection of the bone or bone marrow. It can be usefully subclassified on the basis of the causative organism (pyogenic bacteria or mycobacteria), the route, duration and anatomic location of the infection. Osteomyelitis is an infection of the bone, a rare but serious condition. Bones can become infected in a number of ways: Infection in one part of the body may spread into the bone, or an open fracture that exposes bone to may get infected. In children, osteomyelitis most commonly affects the long bones of the legs and upper arm, while adults are more likely to develop osteomyelitis in the bones that make up the spine (vertebrae). People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers. Once considered an incurable condition, osteomyelitis can be

successfully treated today. Most people require surgery to remove parts of the bone that have died followed by strong antibiotics, often delivered intravenously, typically for at least six weeks.

Signs and Symptoms of the Disease Infection caused by bloodborne microorganisms (hematogenous osteomyelitis); tissue proliferation comes from the infection, including infection, pollution fractures and bone joint replacement surgery. The most common pathogens are gram-positive bacteria. Osteomyelitis caused by gram-negative bacteria can be found in drug addicts, patients with sickle cell anemia and severe diabetes or trauma patients. Fungal and mycobacterial infection lesions are often confined to the bone, causing painless chronic infection. Risk factors include wasting disease, radiation therapy, cancer, diabetes, hemodialysis and intravenous drug use. For children, any the bacteremia process may induce osteomyelitis. Bone infections associated with vascular obstruction can cause bone necrosis and local spread of infection. The infection can spread through the cortical bone to the periosteum, and the formation of subcutaneous swelling of the latter spontaneously penetrate the skin drainage. Thus, if bloodborne: >High fever, tachycardia, general malaise, chills >Pain, swollen, and erythematous areas

If caused by an extension of infection: >Swollen, warm, painful, tender to touch bones or joints

Anatomy and Physiology The bony skeleton is divided into 2 parts: the axial skeleton and the appendicular skeleton. The axial skeleton is the central core unit, consisting of the skull, vertebrae, ribs, and sternum. The appendicular skeleton comprises the bones of the extremities. The human skeleton consists of 213 bones, of which 126 are part of the appendicular skeleton, 74 are part of the axial skeleton, and 6 are part of the auditory ossicles. Hematogenous osteomyelitis most commonly involves the vertebrae, but infection may also occur in the metaphysis of the long bones, pelvis, and clavicle. Vertebral osteomyelitis involves 2 adjacent vertebrae with the corresponding intervertebral disk. The lumbar spine is most commonly affected, followed by the thoracic and cervical regions. Posttraumatic osteomyelitis begins outside the bony cortex and works its way in toward the medullary canal, typically found in the tibia. Contiguous-focus osteomyelitis often occurs in the bones of the feet in patients with diabetes mellitus and vascular compromise.

Pathophysiology In general, microorganisms may infect bone through one or more of three basic methods: via the bloodstream, contiguously from local areas of infection (as in cellulitis), or penetrating trauma, including iatrogenic causes such as joint replacements or internal fixation of fractures or root-filled teeth. Once the bone is infected, leukocytes enter the infected area, and, in their attempt to engulf the infectious organisms, release enzymes that lyse the bone. Pus spreads into the bone's blood vessels, impairing their flow, and areas of devitalized infected bone, known as sequestra, form the basis of a chronic infection. Often, the body will try to create new bone around the area of necrosis. The resulting new bone is often called an involucrum. On histologic examination, these areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process that encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic, it can lead to bone sclerosis and deformity. Chronic osteomyelitis may be due to the presence of intracellular bacteria (inside bone cells). Also, once intracellular, the bacteria are able to escape and invade other bone cells. At this point, the bacteria may be resistant to some antibiotics. These combined facts may explain the chronicity and difficult eradication of this disease, resulting in significant costs and disability, potentially leading to amputation. Intracellular existence of bacteria in osteomyelitis is likely an unrecognized contributing factor to its chronic form.

In infants, the infection can spread to a joint and cause arthritis. In children, large subperiosteal abscesses can form because the periosteum is loosely attached to the surface of the bone. Because of the particulars of their blood supply, the tibia, femur, humerus, vertebra, the maxilla, and the mandibular bodies are especially susceptible to osteomyelitis. Abscesses of any bone, however, may be precipitated by trauma to the affected area. Many infections are caused by Staphylococcus aureus, a member of the normal flora found on the skin and mucous membranes. In patients with sickle cell disease, the most common causative agent remains Salmonella, but Staphylococcus aureus becomes proportionally more common pathogens than in healthy hosts.

Complications of the Disease Osteomyelitis complications may include: Bone death (osteonecrosis). An infection in bone can impede blood circulation within the bone, leading to bone death. The bone can heal after surgery to remove small sections of dead bone. If a large section of bone has died, however, patient may need to have that limb amputated to prevent spread of the infection. Septic arthritis. In some cases, infection within bones can spread into a nearby joint. Impaired growth. In children, the most common location for osteomyelitis is in the softer areas, called growth plates, at either end of the long bones of the arms and legs. Normal growth may be interrupted in infected bones. Skin cancer. If osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer.

Medical-Surgical Treatment The most common treatments for osteomyelitis are antibiotics and surgery to remove portions of bone that are infected or dead. Hospitalization is usually necessary. Medications. A bone biopsy will reveal what type of germ is causing your infection, so your doctor can choose an antibiotic that works particularly well for that type of infection. The antibiotics are usually administered through a vein in your arm for at least four to six weeks. Side effects may include nausea, vomiting and diarrhea. An additional course of oral antibiotics may also be needed for more-serious infections. Surgery. Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following procedures: Drain the infected area. Opening up the area around your infected bone allows your surgeon to drain any pus or fluid that has accumulated in response to the infection. Remove diseased bone and tissue. In a procedure called debridement, the surgeon removes as much of the diseased bone as possible, taking a small margin of healthy bone to ensure that all the infected areas have been removed. Surrounding tissue that shows signs of infection also may be removed.

Restore blood flow to the bone. Your surgeon may fill any empty space left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your body. Sometimes temporary fillers are placed in the pocket until you're healthy enough to undergo a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new bone. Remove any foreign objects. In some cases, foreign objects, such as surgical plates or screws placed during a previous surgery, may have to be removed. Amputate the limb. As a last resort, surgeons may amputate the affected limb to stop the infection from spreading further. Hyperbaric oxygen therapy. In people with very difficult-to-treat

osteomyelitis, hyperbaric oxygen therapy may help get more oxygen to the bone and promote healing. Hyperbaric oxygen therapy is a means of delivering more oxygen than is normally available in the atmosphere. This is done using a pressure chamber that resembles a large, clear tube.

Surgical Treatments may also include: >Surgical Debridement >Sequestrectomy >Bone Grafting

>Antibiotic Beads Health Teaching Take medication exactly as directed. If you were given antibiotics, take all of themeven if you feel better. If you dont finish the medication, the infection may return. Not finishing the medication can also make any future infections more difficult to treat. Be careful in daily life. Your bones have been weakened by the infection. So until the infection is gone and the bone heals, you have a higher risk of breaking a bone. Rest when tired. It is important to save your energy. If you walk around when you are tired, you are more likely to fall and break a bone. Use a splint, sling, or brace as directed by doctor. Doing so helps lower your risk of breaking a bone. Ask doctor about taking calcium supplements.

References: Brunner and Suddharts Medical Surgical Nursing Osteomyelitis: - MayoClinic.com Osteomyelitis | what is a disease at hbfd.org emedicine.medscape.com en.wikipedia.org www.fpnotebook.com

Introduction

J.N. a patient who came from the province was admitted to Philippine Orthopedic Center for an infection of the bone known as Osteomyelitis. Patient probably suffered from a fall. Patient has for a hilot, expecting that this might just be a simple pain. Due to lack of attending proper physiologic needs, such as providing an adequate, nutritious food and seeking proper medical attention, patient has developed osteomyelitis. He then sought consult to a

medical institution and was advised for referral to the Philippine Orthopedic Center.

Our Lady of Fatima University College of Nursing Quezon City

A Case Analysis on Osteomyelitis

Presented by:

Manalo, Maiko Dan T. Group 30