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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. Infecting microorganisms may also reach the bone via the bloodstream, the most common means of bone infection in children. Osteomyelitis is characterized by pain, high fever, and formation of an abscessabscess,
localized inflamation associated with tissue necrosis. Abscesses are characterized by inflamation, which is due to the accumulation of pus in the local tissues, and often painful swelling.
..... Click the link for more information. at the site of infection. Infection may be caused by a variety of microorganisms, including staphylococci, streptococci, and other pathogenic bacteria. Unless treated vigorously with antibioticsantibiotic,
any of a variety of substances, usually obtained from microorganisms, that inhibit the growth of or destroy certain other microorganisms. Types of Antibiotics
..... Click the link for more information. and sometimes surgery, bone destruction may result.
an infectious, inflammatory process that involves first the bone marrow and then elements of one or more bones. Osteomyelitis may be nonspecific—that is, caused by pyogenic cocci or less commonly by the colon or other bacilli—and specific (tuberculous and syphilitic osteomyelitis). Nonspecific osteomyelitis, the more common form, may be hematogenous, in which case the causative agent is in the blood; may be secondary, that is, spread to bone from organs and tissues affected with an inflammatory disease; or may result from exogenous infection of bone from a wound, such as a gunshot wound or an open fracture. The most common forms of osteomyelitis are those that affect the diaphyseal parts of tubular bones; paronychia, which affects the phalanges of fingers; odontogenic osteomyelitis, which affects the jaw; and otogenic osteomyelitis, in which the temporal bone is affected. The disease can develop at any age, and the course may be acute, primary chronic, or chronic as a progression from the acute form. The hematogenous form is most widespread in infants, and the secondary form in adolescents and adults. Gunshot osteomyelitis often complicates the course of extensive wounds during war.
The first symptoms of osteomyelitis are a general and local elevation of temperature with chills, as in sepsis, severe pain in the inflammatory focus, and tenderness and restriction of movement in the affected segment. The disease is diagnosed at this time by roentgenography. Softening in the superficial tissues above the affected site and swelling and reddening in these tissues subsequently arise. Sequestration—formation of portions of the cortical layer of bone that are necrotic from lack of nutrition—is characteristic of osteomyelitis. Small sequestra are sometimes eliminated spontaneously through fistulas that form when purulent discharges break through the skin. Sequestration is a criterion for determining the severity of osteomyelitis and the extent of disability after recovery. In rare cases recovery occurs spontaneously, but the disease may subsequently recur.
Osteomyelitis is treated with anti-inflammatory agents and general and local antibiotics; immobilization and rest of the affected segment of the skeleton are essential. Early incision of the inflammatory focus by periosteotomy—dissection of the periosteum—is indicated. Paracentesis—surgical puncturing in order to aspirate fluid—is performed if inflammatory effusions have spread into the adjacent joints. Sequestra are removed in chronic osteomyelitis. Residual defects and deformities of the bones require conservative and operative treatment, a prerequisite of which is complete suppression of the inflammatory process.
REFERENCESChaklin, V. D. Infektsionnye zabolevaniia kostei, sustavov i khriashchei. Sverdlovsk, 1937.
Fridland, M. O. Ortopediia, 5th ed. Moscow, 1954.
Vengerovskii, I. S. Osteomielit u detei. Moscow, 1964.
V. IU. GOLIAKHOVSKII