OSTEOMILITIS

DEFINISI
 INFEKSI TULANG SETEMPAT /
MENYELURUH
 Berpunca dripada berbagai agen mikrob –
e.g., pyogenic bacteria,mycobacteria,fungi
(kebanyakannya jangkitan staphylococcus
aureus) dan dalam situasi lain termasuk:
 Kecederaan terbuka melibatkan tulang,
seperti kepatahan terbuka.
 Jangkitan bahagian lain badan, seperti
pneumonia atau UTI yang menjangkiti tulang
dan memasuki salur darah(bacteremia,sepsis)
 Minor trauma, yang menghasilkan bekuan
darah sekitar tulang seterusnya menyebakan
jangkitan sekunder daripada rebakan
bakteria
 Luka terbuka yang kronik atau jangkitan
pada soft tissue boleh melemahkan
permukaan tulang, menyebabkan jangkitan
sekunder tulang.

INSIDEN
 Kanak-kanak dan Dewasa.
Picture 1. Osteomyelitis of the elbow
Picture 2. Osteomyelitis of index finger metacarpal head
secondary to clenched fist injury.
Picture 3. Osteomyelitis of index finger metacarpal
head secondary to clenched fist injury.
Picture 4. Osteomyelitis of the great toe.
Picture 5. Osteomyelitis of T10 secondary to streptococcal disease.
Picture 6. Osteomyelitis of diabetic foot.
Picture 7. Osteomyelitis. Radiography of diabetic
foot showing osteomyelitis with gas.
 KAEDAH JANGKITAN
 Tembusan kulit 
luka
 Absess
 Infeksi saluran
 Jangkitan melalui
pusat
 pengkateteran
 ORGANISMA PENYEBAB
 STAPHYLOKOKUS
 STREPTOKOKUS
 SALMONELLA PNEUMONIA
 HAEMOPHILUS INFLUENZA
 E. COLI
 PATOLOGI
 KETERUKAN BERASASKAN FAKTOR
 UMUR
 LOKASI JANGKITAN
 KEVIRULAN ORGANISMA
 IMUNITI PESAKIT

 CIRI-CIRI PATOLOGI ADALAH :-

 KEADAAN INFLAMASI
 SUPPURASI
 NEKROSIS
 PEMBENTUKAN TULANG BARU
 PENYEMBUHAN
 LOKASI SERING BERLAKU
 HUJUNG DISTAL FEMUR
 HUJUNG PROKSIMAL TIBIA
 HUJUNG HUMERUS,ULNA,RADIUS
 TURUS VETEBRA (DEWASA)
 CIRI KLINIKAL

Hematogenous long-bone osteomyelitis

Demam tinggi secara tiba-tiba.
(fever is present in only 50% of neonates with
osteomyelitis)
lemah
Cepat marah / tidak selesa
lemah
Restriction of movement (pseudoparalysis of limb in
neonates)
Local edema, erythema, and tenderness
Hematogenous vertebral osteomyelitis
Bermula secara tanpa disedari (Insidious onset)
Sejarah “an acute bacteremic episode”
May be associated with contiguous vascular insufficiency
Local edema, erythema, and tenderness
Chronic osteomyelitis

Luka yang tidak sembuh

Sinus tract drainage
Chronic fatigue
Malaise
Physical: Findings at physical examination may include the
following:

•Demam (present in only 50% of neonates)

•Bengkak
•Panas
•Keadaan yang tidak menentu (fluctulance)
•Ketegangan semasa palpasi
•Reduction in the use of the extremity (eg, reluctance to
ambulate, if the lower extremity is involved or pseudoparalysis
of limb in neonates)
•Sinus tract drainage (usually a late finding or one that occurs
with chronic infection)
 Penyiasatan makmal

 HB, TWDC
 Blood C&S

 Imaging Studies:

 Radiography
 MRI
 Radionuclide bone scanning
 Ultrasonography
Diagnosis requires 2 of the 4 following criteria:
 Purulent material on aspiration of affected
bone
 Positive findings of bone tissue or blood
culture
 Localized classic physical findings of bony
tenderness, with overlying soft-tissue
erythema or edema
 Positive radiological imaging study
 Consultations: Order an orthopedics,
general surgery, or infectious disease
consultation, as needed.
 Diagnosa perbezaan
 Piogenik arthritis
 Poliomilitis
 Deman reumatik
 Syphilitis metafisitis.
 Rawatan dan pengurusan
Emergency Department Care:
Osteomyelitis rarely requires emergent stabilization or resuscitation.
The primary challenge for ED physicians is considering the appropriate
diagnosis in the face of subtle signs or symptoms.

Rawatan dan pengurusan:

 Rawatan sokongan

 Larang gerak

 Terapi antibiotik (i/V - 8/52  oral 2 – 3/52)

Initiation of intravenous antibiotics that penetrate bone and joint cavities

Select the appropriate antibiotics using direct culture results in samples from the infected site,
whenever possible. Empiric therapy is often initiated on the basis of the patient's age and the
clinical presentation. Further surgical management may involve removal of the nidus of infection,
implantation of antibiotic beads or pumps, hyperbaric oxygen therapy, or other modalities.
Penyaliran absess

Resection

Surgical debridment

Management of resultant dead

space & bone grafting
 komplikasi
 Complications:

 Bone abscess
 Bacteremia
 Fracture
 Loosening of the prosthetic implant
 Overlying soft-tissue cellulitis
 Draining soft-tissue sinus tracts

 Prognosis:

 The prognosis is variable but markedly improved with timely

diagnosis and aggressive therapeutic intervention.
 Sekian
terima kasih