Osteomyelitis.The proper treatment and clinical management of osteomyelitis osteomyelitis (ŏs'tēōmī'əlī`tĭs), infection of the bone and bone marrow. Direct infection of bone usually occurs through open fractures, penetrating wounds, or surgical operations. (bone infection) depend on a successful correlation of its clinical features with radiologic and pathologic findings. Diagnostic difficulties may arise, and the final arbiter is intraoperative culture. The importance of intraoperative culture obtained in a "sterile" environment cannot be overemphasized. The three general categories of osteomyelitis are acute, chronic, and tuberculous tuberculous /tu·ber·cu·lous/ (too-ber´ku-lus) pertaining to or affected with tuberculosis; caused by Mycobacterium tuberculosis. tu·ber·cu·lous adj. 1. (the latter is not seen in head and neck locations). Most patients with acute osteomyelitis in the head and neck present with mandibular disease. Osteomyelitis is being seen with increasing frequency in patients with chronic diseases such as diabetes and peripheral vascular disease Peripheral Vascular Disease Definition Peripheral vascular disease is a narrowing of blood vessels that restricts blood flow. It mostly occurs in the legs, but is sometimes seen in the arms. and in patients with poor dental hygiene; it is uncommon in healthy adults. Because adult patients often present with pain and without an associated fever, a high index of suspicion index of suspicion Medtalk A phrase broadly used to indicate how seriously a particular disease is being entertained as a diagnosis; as an example, there is a high IOS that rapid and unexplained weight loss in an elderly Pt is due to pancreas CA, and a low IOS that and the appropriate cultures are required to establish the correct diagnosis and appropriate treatment. The histologic features include marrow edema edema (ĭdē`mə), abnormal accumulation of fluid in the body tissues or in the body cavities causing swelling or distention of the affected parts. and delicate fibrosis with acute inflammatory cells and bone resorption (figure 1). [FIGURE 1 OMITTED] Chronic osteomyelitis is often the result of incomplete treatment of acute osteomyelitis. Approximately 15 to 30% of patients with acute osteomyelitis will develop chronic osteomyelitis. Signs and symptoms of the chronic form are usually less prominent and may fluctuate in severity; they include swelling, pain, sinus formation, sequestration and, in the case of bone loss, pathologic fractures. The histologic features are marrow fibrosis with scattered mononuclear cells (figure 2). Long-standing chronic osteomyelitis is associated with squamous cell carcinoma squamous cell carcinoma n. A carcinoma that arises from squamous epithelium and is the most common form of skin cancer. Also called cancroid, epidermoid carcinoma. in approximately 1% of patients. [FIGURE 2 OMITTED] The treatment of acute osteomyelitis involves an armamentarium ar·ma·men·tar·i·um n. pl. ar·ma·men·tar·i·ums or ar·ma·men·tar·i·a The complete equipment of a physician or medical institution, including drugs, books, supplies, and instruments. of antibiotic agents in addition to debridement Debridement Definition Debridement is the process of removing nonliving tissue from pressure ulcers, burns, and other wounds. Purpose Debridement speeds the healing of pressure ulcers, burns, and other wounds. and removal of dead bone. Chronic osteomyelitis is more difficult to manage unless all necrotic bone and organisms are removed. Occasionally, resection of large parts of the mandible is necessary to achieve this goal. Suggested reading Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am 2004;86-A:2305-18. Lew DR Waldvogel FA. Osteomyelitis. Lancet 2004;364:369-79. Francis H. Gannon, MD; Lester D.R. Thompson, MD From the Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, Calif. |
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