Osteomyelitis | Symptoms & Causes🩺

Osteomyelitis | Symptoms & Causes🩺

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▬▬▬▬▬▬▬▬▬▬ Contents of this video ▬▬▬▬▬▬▬▬▬▬

Defining Osteomyelitis (OM); Pyogenic & non-pyogenic infections.
STAPH. AUREUS; most common organism in pyogenic OM & importance of this fact in directing empirical antibiotic therapy.
Mycobacterium Tuberculosis; most common organism in non-pyogenic OM.
POTT'S DISEASE; OM involving vertebrae; common in adults.

Routes of entry of organism into Bone Marrow (BM):
1-Hematogenous spread/route.
OM in children; long bone internal anatomy explained; significance of involvement of Metaphysis of long bones in OM of children.
Pott’s Disease; vertebral involvement through hematogenous route; Bacteremia.

Routes of entry continued;
2-Direct extension from neighboring Soft Tissue Infections; periosteal breach, example: DIABETIC FOOT ULCER.
Mechanism of development of Diabetic Foot Ulcer: Atherosclerosis & Ischemia, Immunocompromised & Infection, DIABETIC NEUROPATHY & inadvertent repetitive trauma.
Ulcer deepens to the level of bones leading to OM.
3-Microbes’ direct implantation into bone: Penetrating injury, surgery & Open Fractures.

Pathophysiology of Osteomyelitis (OM): Blood supply in long bones; nutrient artery; significance of Hair Pin Turn Loops.

Pathophysiology of OM continued: High rates of OM in children; settling of bacterial infection in Hair Pin Turn Loops of Metaphysis occurs relatively easily, for following reasons:
1-Blood flow pattern favors the bacterial settling in the metaphysis.
2-Low phagocytic cell activity.
3-Bacteria express cell surface molecules that help bacteria attach itself to collagen, fibronectin; stay there and multiply.
Staph. Aureus; SUPPURATIVE INFLAMMATION; spread of pus along the path of least resistance; pattern of spread of pus & its relation with distribution pattern of Metaphyseal & Epiphyseal Vessels in children younger than 1 year & older than 1 year; significance of avascular epiphyseal plate in children older than 1 year.
SUPPURATIVE SEPTIC ARTHRITIS; [in infants younger than 1 year] interconnection b/w Epiphyseal & Metaphyseal vessels; destruction of articular cartilage & permanent damage to joints.

Pathophysiology of OM continued: microscopic structure of long bones is described; Osteons, HAVERSIAN CANALS & Osteocytes.
Cross & Longitudinal section of Haversian Canal/Osteon; Horizontal Vascular interconnections b/w neighboring Haversian Canals; VOLKMANN CANALS.
Haversian System in detail; Periosteum, Periosteal & Cortical arteries.

Pathophysiology of OM continued: Development of SUB PERIOSTEAL ABSCESS; severing of periosteal vessels; NECROSIS.
Destruction, thrombosis of blood supply from Medullary & Periosteal side; disconnection from any functional vascular system; ISCHEMIC NECROSIS of involved segment of the bone; DEAD piece of bone; SEQUESTRUM.
Conversion of ACUTE OM into CHRONIC OM.

Pathophysiology of OM continued: PERIOSTEAL REACTION; arrival of Mesenchymal Osteoprogenitor Cells (“Sleepy Cells”); conversion into Osteocytes & new bone formation in lifted periosteum; REACTIVE BONE FORMATION.
Formation of INVOLUCRUM; newly formed vascular bone with no defined structure.

Long-term complications;
Sub periosteal pus may rupture into surrounding tissues; involucrum partly digested, pus coming out through openings in the soft tissue; formation of CLOACA, SINUSES & epithelization of sinuses.
Need for surgical removal.
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