Osteomyelitis is an infectious disease. Osteomyelitis of bones

In MBK-10, the disease is assigned code M86, which belongs to the group “other osteopathies” M86-M90.

The disease is very serious and difficult to treat, so early timely consultation with a doctor can significantly increase the chances of recovery. With proper treatment, there is a chance of quickly clearing the body of infection, avoiding bone destruction and serious complications.

Causes

The entry of pathogenic bacteria into the bone and the formation of a purulent inflammatory process leads to osteomyelitis, which is facilitated by foci of latent infection, weakening of the body, and weak immunity. The mechanism for the development of the disease can be triggered by injuries, burns, acute respiratory viral infections, frostbite, heavy lifting, frequent colds, drug use, as well as:

Vascular atherosclerosis;
osteoporosis;
systemic lupus erythematosus;
furunculosis, carbunculosis;
Crohn's disease;
sickle cell anemia;
decompression sickness;
myeloproliferative diseases;
previous splenectomy;
severely infected wounds;
varicose veins;
diabetes;
renal dysfunction.

Bacteria can enter the body through damaged skin, nasopharyngeal mucosa, in infants - through the umbilical wound, abrasions and diaper rash, from an infected mother, while in the fetal state. In older children - through lesions in the adenoids, tonsils, in the oral cavity due to caries, etc.

Localization

Most often, the localization of osteomyelitis is observed in long tubular bones, femur and tibia, less often in flat bones (pelvis, jaw), humerus and fibula. Recently, a rare phenomenon has been observed - the occurrence of osteomyelitis in the temporomandibular joint, characterized by limitation and pain when opening the mouth. Osteomyelitis of the sternum and ribs is also a rare localization. In newborns, pathology often occurs in the epiphyseal area, which, if left untreated, can stop the growth of the limb and lead to deformation that destroys the joint.

Classification

Among the many types of osteomyelitis, several of the most common ones that affect the diagnostic process stand out: acute hematogenous, post-traumatic, chronic.

Acute hematogenous osteomyelitis

This type occurs when pathogenic microorganisms enter the intraosseous vessels and form a purulent focus. Children aged 3-14 years are most susceptible to the disease, and somewhat less frequently - newborns, as well as old people and adults with the risk factors listed above. This is especially true for males due to higher physical activity and susceptibility to injury.

Variants of the course of the disease

Breakaway: the most favorable option, in which the body’s reaction is very pronounced, recovery processes occur as quickly as possible, recovery occurs in 2-3 months.
Prolonged osteomyelitis: can be cured in 6-8 months, although in this type of disease the course of the disease is subacute, long-term, with a low immune status.
Fulminant: is the most deplorable variant of the disease, characteristic of hematogenous osteomyelitis with infection by Staphylococcus aureus. Bacteria are released into the blood en masse; when they break down, they release aggressive endoxin. The result is a rapid drop in blood pressure to zero, brain death.
Chronic the variant of osteomyelitis lasts a long time, periods of remission and exacerbations alternate, fistulas open and close, and areas of dead tissue form. Fistulas, in turn, provoke an inflammatory process.

Post-traumatic osteomyelitis

The development of the disease is facilitated by the entry of bacteria through open contact with a contaminated environment, during fractures, various types of wounds, in the postoperative period, etc.

Primary chronic osteomyelitis

Decreased immunity and the use of antibiotics contribute to the occurrence of this form of the disease. It has a sluggish course, making diagnosis difficult.

Symptoms

There are two forms according to the clinical course: local and generalized.

Local osteomyelitis

In this form, the patient feels severe bursting pain in the affected bone. With light tapping, the location of the pain is determined, movements are limited, the areas of the skin above the source of inflammation are hot with redness, severe swelling is characteristic, strong tension of the skin visually causes a feeling of shine, body temperature is 37.5-38.5. When a fistula forms and pus breaks out from the periosteum, a decrease in pain and signs of inflammation is observed.

Generalized osteomyelitis

The initial process is identical to the local form, but then symptoms of intoxication appear. The temperature rises to 39-40 degrees, chills are felt, and sticky cold sweat appears. Purulent damage to the lungs, kidneys, purulent pericarditis, endocarditis, and brain damage may appear. Appear: rash, convulsions, severe headaches. As brain damage progresses, stupor occurs, then precoma and coma.

Diagnostics

Only a competent specialist can determine an effective course of treatment, which is preceded by a correct diagnosis. With post-traumatic osteomyelitis, listening to the patient's complaints and visual examination is enough to make a preliminary diagnosis. But additional examinations are needed to confirm it. In addition to the usual general tests, a biochemical blood test and instrumental methods are used.

The capabilities of hardware diagnostics make it possible to use various methods to find out the location of purulent tracts and determine exactly the degree of bone destruction. The following may be prescribed for this:

Radiography;
Scintigraphy;
Ultrasound;
CT scan;
Densitometry;
Magnetic resonance imaging;
Radionuclide diagnostics;
Bone puncture, etc.

To correctly prescribe an antibiotic, the purulent contents are examined to determine the pathogens. Computed tomography is very sensitive; when it is performed, it is possible to examine in detail all the defects of the damaged bone. Magnetic resonance imaging exceeds the capabilities of computer imaging and provides a more accurate picture; if possible, preference should be given to the latter. Ultrasound gives a picture of the accumulation of pus, the length of the fistula tracts, the state of blood circulation in the affected area and changes in the periosteum. The most accurate is radionuclide diagnostics, but due to the high cost of equipment, examination is possible only in specialized medical centers.

Treatment

To stop the inflammatory process, it is necessary to use splints, corsets, and a plaster splint, especially if the tibia is damaged. Bed rest is also important to preserve the strength that will be needed in the fight against the disease and to prevent bone overload.

For successful treatment, it is important to take comprehensive measures, including:

Drug therapy;
Use of antiseptic solutions and ointments;
Physiotherapeutic treatment;
Diet food;
Strengthening immunity;
Additionally, the use of traditional methods;
Massage;
exercise therapy;
Surgical intervention.

Drug treatment

After diagnosis, the doctor selects treatment in such a way as to select several of the most suitable antibiotics in this case. In case of osteomyelitis, the use of Lincomycin, Co-Trimoxazole, Vancomycin, Kefzol, Cetriaxone, Fuzidin is effective.

Also, appropriate specialists prescribe medications to correct glucose levels, electrolyte balance, etc. If drug treatment is ineffective, surgery is used.

Surgery

In surgery there is a rule to remove any purulent focus. The operation is indicated if a phase of pus formation is detected. The affected bone cavity is cleaned when the lesion is opened and washed with antiseptics. A drainage tube is inserted into the wound, which is brought out, and the wound is dried. For about a week, the bone marrow canal is washed with drainage. Then the tube is removed, and a muscle flap of its size is placed into the resulting cavity. This prevents bacteria from entering and worsening osteomyelitis. The wound is then sutured and a small drain is left in the soft tissue, which is then removed once the wound has healed.

Other types of treatment:

Physical procedures: after the operation, electrophoresis is prescribed for a week using weak antibiotics, followed by ultraviolet irradiation.

Physiotherapy: three weeks after the operation, the area of ​​the affected bone is spared, but all other parts of the body are given a light load, in order to avoid bedsores and to keep the body in good shape.

Folk remedies: doctors say that osteomyelitis cannot be treated with traditional methods, otherwise the disease can be advanced too much, which will lead to serious consequences. But, in combination with conservative treatment, natural remedies can bring relief and improve the patient’s condition. These include:

Walnut, recognized as a good natural antiseptic, in the form of tinctures and compresses;
onion compresses in the chronic phase of the disease;
consumption of fish oil, yarrow infusion, lilac flowers;
baths of currants and nettles.

Look at how it is used in folk medicine.

Complications

In case of any form of osteomyelitis, it is very important to remove pus from the bone to prevent its spread throughout the body. Otherwise, blood poisoning is possible, followed by sepsis, then death.

Possible complications:

Bone deformation;
Purulent arthritis;
Pathological fractures;
Deformation of internal organs;
Infectious arthritis;
Arrosive bleeding;
Malignancy of fistula walls;
Malignant tumors;
anemia;
Kidney damage;
Abscess or cellulitis.

Prevention of osteomyelitis

This disease is difficult to treat, so it is necessary to take measures to protect yourself. In case of fractures, you should immediately seek medical help, treat wounds with antiseptics, treat chronic diseases that are foci of infection: tonsillitis, caries, sinusitis, etc. An important role in the prevention of osteomyelitis is played by strengthening the immune system, proper nutrition, exercise, and getting rid of bad habits.

In case of osteomyelitis, a conclusion on fitness for military service is made after a detailed examination. It depends on the results, which indicate the condition of the bones, the possibility of relapses, the persistence of recovery, and the predisposition to progression. After this, a decision is made on the conscript’s suitability for military service.

Features of osteomyelitis in children

Children often develop acute hematogenous osteomyelitis, and if it is not treated correctly, the consequences can affect adulthood in the form of a chronic form of the disease. For prevention in children, it is recommended to timely eliminate the source of inflammation, maintain immunity, balanced nutrition, and proper care. Inflammation of the jaw bones also often occurs in children. In advanced cases, if not treated in a timely manner, it can lead to the child losing teeth and jaw deformation.

Osteomyelitis is a serious disease that requires timely contact with an orthopedist-traumatologist. This will help maintain health and avoid serious disruptions in the functioning of the body.

Osteomyelitis is a disease that includes inflammation of the bone (ostitis), periosteum (periostitis), and bone marrow (myelitis). The route of infection into bone tissue can be hematogenous (with blood flow). This type of bone osteomyelitis is more common in childhood and adolescence. Hematogenous osteomyelitis usually develops after infections (otitis media, sinusitis, measles, scarlet fever, caries, pneumonia). There are 3 possible forms of the process: septic-pyemic, local, adynamic (toxic).

Exogenous entry of infection is possible - from the external environment. This is observed in open injuries with damage to bone tissue, gunshot wounds, after surgery on bones using metal structures (post-traumatic osteomyelitis) and when the inflammatory process moves from soft tissue to bone (contact), this occurs with an abscess and phlegmon. Let us consider in detail how osteomyelitis is treated, what kind of disease it is, and how to recognize it.

The causative agents of hematogenous osteomyelitis are most often streptococci and staphylococci. With the post-traumatic development of infection, it can be a combination of microorganisms, often Pseudomonas aeruginosa, Escherichia coli.

Factors contributing to the development of osteomyelitis:

• smoking, drug addiction, alcoholism;
• vascular diseases (atherosclerosis, varicose veins);
• foci of chronic infections;
• oncological diseases;
• splenectomy;
• elderly age;
• decreased immunity;
• prolonged hypothermia;
• stress;
• malnutrition.

According to the variants of the course, acute, chronic, fulminant, protracted, and also primary chronic osteomyelitis, including atypical forms, are distinguished. These include Brody's abscess, Ollier's albuminous osteomyelitis, Garre's sclerosing osteomyelitis, and antibiotic osteomyelitis.

Based on the localization of the process, osteomyelitis of tubular, flat, and mixed bones is distinguished. Osteomyelitis of tubular bones is divided according to location into diaphyseal, metaphyseal, epiphyseal, mixed (metaphyseal, etc.), total.

Clinic

There are general and local symptoms of osteomyelitis. General manifestations are nonspecific, they are caused by bacteremia. These are chills, increased body temperature, tachycardia, weakness, fatigue, decreased performance, and drowsiness.

After a few days, local signs of osteomyelitis appear in the affected area: redness of the skin, swelling, local rise in temperature, limitation of movements, pain, a feeling of bursting inside the bone in the affected area. The pain syndrome increases with movements and tapping on the bone.

Later, fistulas with purulent discharge appear. After the fistula breaks through, pain and other signs of inflammation decrease. In chronic osteomyelitis, the presence of old fistula tracts can be seen.

Atypical forms differ in their characteristics. Brody's abscess is characterized by a poor clinical picture. This form of osteomyelitis develops with good immunity. Localization of the pathogen is formed by encapsulating an intraosseous abscess. Pain is detected when the bone is tapped. The X-ray picture is specific - periostitis is weakly expressed, a cavity is found in the bone.

In albuminous osteomyelitis, the soft tissue around the bone becomes saturated with fibrin. Radiologically, the picture of periostitis is not clearly expressed; fibrinous deposits are detected.

Antibiotic osteomyelitis occurs when antibiotics are taken irrationally. The concentration of the drug is insufficient to destroy the microbe. It is encapsulated. The clinic is sluggish, asymptomatic.

With sclerosing osteomyelitis, a subacute onset is noted, with an increase in temperature to subfebrile levels. Periods of remission are followed by exacerbation. Sclerosis of the bone marrow canal occurs, which is confirmed by x-ray.

Diagnostics

In addition to examining the patient, questioning complaints, and ascertaining the medical history, laboratory examinations (CBC, urine, blood biochemistry), and radiography are carried out.

A blood test reveals an increase in the level of leukocytes, a shift in the leukocyte formula to the left, and an increase in ESR. These changes are characteristic of inflammation.

X-ray changes do not appear immediately. They are delayed by 10–14 days compared to the clinic.

An x-ray can identify signs of periostitis, osteoporosis of bone tissue, and sequestration. Against this background, there may be a pathological fracture.

In addition to radiography, there are more accurate diagnostic methods that can detect pathology at an early stage. These are CT and MRI. Moreover, computed tomography can only show the layer-by-layer structure of bone tissue, while MRI, in addition to this, will also give an idea of ​​the condition of the soft tissues. MRI is the method of choice for diagnosing osteomyelitis.

An additional examination method is ultrasound, which allows one to determine the presence of purulent leaks, fistulas, the condition of the periosteum, and blood circulation.

When performing fistulography, a contrast agent is injected into the fistulous tract and pictures are taken. Thus, it is possible to identify the true size and direction of the fistula.

Radionuclide diagnostics is a modern, expensive research method for osteomyelitis. It is based on the ability of radioactive drugs to accumulate in the lesion of bone tissue.

After confirming the symptoms of osteomyelitis with the data of instrumental examination methods, treatment begins.

Treatment

Treatment of osteomyelitis is carried out in an inpatient setting at a specialized O departments (traumatology, surgery), follow-up treatment is possible on an outpatient basis. The patient must be provided with adequate nutrition containing sufficient amounts of proteins, fats, carbohydrates, vitamins and minerals.

A set of measures is used, including conservative and surgical treatment. Let's consider conservative methods.

Antibiotic therapy - broad-spectrum drugs are prescribed. Lincomycin has the ability to penetrate bone tissue. It is the drug of choice in the treatment of osteomyelitis. In severe cases of the disease, a combination of 2-3 drugs is used.

If there is such a possibility, then the sensitivity of the causative agent of osteomyelitis to various antibiotics is determined and treatment is carried out taking this into account. It is better to use the injection method of administering antibiotics (intravenous, intraarterial, intramuscular). It is more effective compared to taking tablet forms. Intraosseous administration of drugs during surgery is also used.

Immobilization of the damaged area. For this purpose, a plaster splint is applied. Creating immobility of the affected area helps reduce inflammation.

Normalization of microbial flora. To do this, in parallel with taking antibacterial drugs, Bifiform, Linex and other drugs that restore intestinal biocenosis are prescribed.

Plasmapheresis, hemosorption, ultraviolet or laser irradiation of blood are carried out to stimulate the body's defenses and remove toxins.

The abscess is opened surgically, washed, drained, sequestered, purulent, and fistulas are removed. Bone perforation (osteoperforation) is performed in several places, and the bone marrow canal is washed with antiseptics.

This helps to decompress the medullary canal, reduce pain, improve blood supply to areas of inert tissue, and stimulate bone tissue regeneration. Replenishment of the bone defect is carried out by performing osteosynthesis with an Ilizarov apparatus, filling bone tissue, and autotransplantation of its fragments.

After the acute process has subsided, exercise therapy, physiotherapy ((lack of movement) are prescribed during the rehabilitation period), contracture (limited mobility) in the joints occurs due to prolonged immobilization, the formation of scar adhesions due to purulent inflammation in the joints;

• Are common:
• sepsis;
• anemia due to chronic disease;

Amyloidosis of internal organs (usually kidneys), developing as a result of a long course of the infectious process. Preventing the development of complications is to seek medical help early. It is necessary to promptly diagnose and properly treat the disease.

Video: About the most important thing: osteomyelitis

Sources

1. Traumatology and orthopedics. Textbook for students of medical institutes, edited by Yumashev G.S. Publishing house "Medicine" Moscow. ISBN 5-225-00825-9.

A disease such as osteomyelitis is an inflammatory infectious process that develops in the bone (tibia, femur, tibia, calcaneus, clavicle, hip, jaw), bone marrow, and often spreads to soft tissue. Bone osteomyelitis is a very serious pathology, since all structural elements of the bone are involved in the purulent-necrotic process. It can lead to serious consequences and even disability.

The development of the disease and its localization depend on several factors, such as the general condition of the human body, including the level of immunity, the degree of susceptibility to infection, local changes in bone tissue of a morphological and circulatory nature.

The causative agents are various viruses, fungi, bacteria, including staphylococci (about 50% of all cases), rickettsia, pneumococci, E. coli, streptococci, salmonella. In rare cases, the pathology is caused by gram-negative microflora. The causes of osteomyelitis can be infection of soft tissues, as well as acute fractures, which allows bacteria to penetrate the human body through the wound. In some cases, the disease is a complication after syphilis, tuberculosis, or leprosy.

Traumatic and hematogenous osteomyelitis are distinguished. The form of the disease is determined by the entry of bacteria into the body that cause pathology. This criterion distinguishes the hematogenous form of the disease, when bacteria enter the bones internally, that is, they are transferred from the pathogenic focus through the bloodstream. This, for example, can occur due to tonsillitis, caries, intestinal fistula, sinusitis and other diseases. The second type of osteomyelitis is traumatic, when bacteria are transmitted externally due to certain injuries (fractures, non-sterile surgical interventions, gunshot wounds, and so on).

Depending on what part of the body the disease affects, its manifestations differ slightly. This may involve the tibia, femur, clavicle, tibia, cranial, jaw or calcaneus. Symptoms, as well as treatment, differ in each individual case.

Signs of hip osteomyelitis

If the lesion affects the femur, then, first of all, pain is observed in the hip and knee joint. In addition, the normal functioning of the limb is disrupted, a purulent fistula and general intoxication may occur. With pathology of the hip joint, a sharp and acute pain is felt in the buttock area (right or left, depending on the location of the lesion). A person may experience discomfort and pain while sitting. If the femoral diaphysis is affected, which is called Garré osteomyelitis, then thickening of the diaphysis, swelling of nearby tissues, and excessive formation of connective tissues occur.

Signs of osteomyelitis of the leg

The initial symptom of damage to the lower leg is severe pain when walking, standing, trying to stand up, or physical activity of any nature. The lower leg turns red and swells, takes on a forced state, and pulsation is felt in the sore area. Sometimes there is an increase in temperature, restriction of movement, chills are observed, the general condition worsens, and the venous pattern intensifies. After the fistula breaks through, the pain subsides and the pulsation stops. If treatment is not provided on time, thrombophlebitis is a complication of osteomyelitis of the leg.

Signs of osteomyelitis of the tibia

The symptoms in this case are pain, which tends to intensify with any movement, physical activity, swelling of the soft surrounding tissues, thickening of the cortical layer of the bone, as well as soft tissues and their deformation. In addition, a narrowing of the bone marrow canal, increased temperature, chills and deterioration in general health may be observed. The general activity of a person decreases due to the above symptoms.

Signs of osteomyelitis of the calcaneus

When the heel bone is affected, the initial symptom is the inability to stand on the limb where the disease develops. A person, getting to his feet, experiences a strong and sharp pain syndrome. The formation of a fistula is also possible, and if treatment is not carried out on time, it contributes to the erosion of the soft surrounding tissues of the heel area. As a result, an open wound forms, which prevents normal human movement. The general symptoms are the same as in the cases described above: fever, chills, deterioration in general health.

Signs of osteomyelitis of the jaw

The list of causes that cause this pathology in the area of ​​the jaw bones includes chronic infections such as sinusitis or tonsillitis, various acute infections such as scarlet fever, diphtheria or tonsillitis. Also, the appearance of the disease can be caused by various injuries to the jaw, such as fractures and wounds. Diseased teeth can also cause this disease. The lower jaw is most often affected.

Common symptoms include fever, lack of appetite, chills, headache, and body weakness. Local signs are the following: pain in the area of ​​the diseased tooth, which manifests itself strongly when pressing on it. There is a high probability that the affected tooth, as well as its neighbors, will become loose. The gums become red, sore, and swollen. In addition, the lymph nodes in the neck may become enlarged and painful. In some cases, a fistula may develop in the gum with the gradual discharge of pus from it.
Jaw osteomyelitis can lead to various complications if it is not treated in a timely manner. These are problems such as abscess, impaired jaw mobility, pathological fractures, phlegmon of soft cervical tissues and even blood poisoning (sepsis). In order to prevent such serious complications from arising, it is necessary not only to start treatment on time, but also to always consult a doctor if you see the appearance of diseased teeth, and also visit the dentist regularly.

Signs of clavicle osteomyelitis

Factors that cause the appearance of this form of the disease are dislocations, unsuccessful operations, especially with the use of foreign bodies (wires, plates), fractures, and pathogenic microflora entering the bone through the bloodstream. Osteomyelitis of the clavicle of a hematogenous nature often occurs as a result of chronic infections and frequent injections, such as, for example, chronic hemodialysis, diabetes mellitus and others. Symptoms of the disease are pain in the affected area, redness of the skin, inflammation of the lymph nodes located above and below the collarbone.

It must be said that the cranial bones, compared, for example, with the heel or other bones, are not affected so often. But if the disease affects precisely these areas, then the consequences can be very serious, sometimes ending in death if treatment is started at the wrong time or is not appropriate. A particular danger is that after opening the abscess and releasing the pus from it, the person’s well-being may improve and the pain may subside. But this is only an appearance, because bone destruction continues.

Acute form of osteomyelitis

The acute form of the disease is typical for both adults and children, while the chronic form of this disease is not observed at an early age. The onset of the acute process is associated with widespread inflammation localized in the bone marrow. As the disease progresses, phlegmon develops, bone marrow necrosis is observed, and spongy tissue is damaged, as well as sometimes the lamina compacta. Not on the third or fourth day from the onset of the pathological process, ulcers appear. The next stage in the development of the acute form is the spread of infection to the periosteum, and then to the soft tissues.

Treatment of the acute form includes osteoperforation, which consists of opening and draining the bone marrow canal, decompression, improving blood circulation, and relieving pain. All these measures prevent the spread of the pathological process. Treatment of the acute form necessarily includes antibiotics, as well as methods aimed at increasing the overall tone of the body. If done on time, it can prevent the development of an abscess and the appearance of areas of necrosis.

Chronic form of pathology

There are several reasons for the transition of the acute form of osteomyelitis to the chronic form. These include untimely treatment, incorrect surgical intervention, errors in prescribing antibiotics, the occurrence of an osteomyelitic cavity, and pathomorphological changes. For all or one of the above reasons, the disease becomes chronic over two to three months. That is why it is necessary to seek medical help at the first signs of pathology, and not wait until the patient’s motor function is impaired.

There are two stages of chronic osteomyelitis: relapse and remission. During the period of relapse, antibiotics and other therapeutic measures help muffle the symptoms of the disease. But this is just an appearance and does not mean complete recovery. And for this reason, remission occurs - a period of calm and absence of any symptoms of pathology.

Chronic osteomyelitis consists of two stages: relapse and remission. Due to weakened immunity, injury, hypothermia, the disease reaches its highest point. Under the influence of a number of antibiotics, the symptoms of the disease are muffled, but a complete cure does not occur. As a result, the second phase begins - remission. However, if a fistula forms, it will not be possible to completely suppress the symptoms.

Diagnostic measures

Timely diagnosis is a guarantee that treatment of the disease will be successful. The main thing in diagnosis is an x-ray of the affected area. In addition, blood tests (biochemical, general and structural), ultrasound, magnetic resonance and computed tomography are also prescribed. The blood sample shows an increased erythrocyte sedimentation rate as well as an increased white blood cell count. To accurately determine this bone pathology, an analysis of bacterial microflora is prescribed in some cases. More rarely, a bone puncture of the leg that is affected by the disease is prescribed.

It must be remembered that in approximately 25 percent of cases the outcome of the disease is death. Even with the current level of medicine, this bone disease is considered dangerous to human life. Therefore, if you feel even minor pain in the head, lower leg, thigh, or heels, you should immediately seek medical advice.

Video about osteomyelitis

Osteomyelitis of the leg is a purulent infectious inflammation of the bones of the leg (tibia and fibula), affecting all elements of the bone - bone marrow, the bone tissue itself and the covering tissue of the bone - the periosteum.

Osteomyelitis of the tibia is more common (in 80% of cases). However, if the inflammation primarily occurs in one of the bones of the leg, it always spreads to the adjacent bone.

If osteomyelitis occurs for the first time, it is called acute. If osteomyelitis occurs over a long period of time and periodically worsens, it is called chronic.

Osteomyelitis of any bone is always caused by the penetration of pathogenic microorganisms in various ways. It is extremely rare that osteomyelitis is not infectious in nature and bone inflammation occurs against the background of activation of the immune system.

The causes of osteomyelitis of the leg can be:

• penetration of microbes through blood vessels into the bones of the leg from a distant source of infection (hematogenous form of osteomyelitis);
• direct penetration into the bone during wounds, fractures, operations on the bones of the leg (non-hematogenous osteomyelitis).

Even 25-30 years ago, acute hematogenous osteomyelitis of the leg occurred in most cases in childhood; currently, osteomyelitis of the leg occurs with equal frequency in children and adults.

The causes contributing to the occurrence of osteomyelitis of the leg are:

• atherosclerosis of blood vessels of the lower extremities;
• chronic alcohol intoxication;
• diabetes;
• immunodeficiency;
• fractures of the lower leg bones (especially open ones).

The disease begins rapidly with an increase in body temperature to 38-39 ºC, general malaise, and weakness. Intense pain in the lower leg area occurs and quickly increases, depending on the location of the purulent focus, in the upper or, more often, in the middle third of the lower leg along the front surface. Osteomyelitis of the lower leg bones is always accompanied by inflammation of the knee, less often the ankle joint.

The skin in the area of ​​the lesion is red, palpation is sharply painful, movement in the affected limb causes unbearable pain. The development of external signs of inflammation - redness, swelling, severe pain - indicates the destruction of the bone frame by purulent inflammation and the release of pus into the intermuscular space. In the absence of adequate treatment, symptoms of intoxication and dehydration quickly increase. The presence of an unopened abscess in the bones of the leg and soft tissues of the leg leads to the development of sepsis. Swelling and redness of the skin increase, spreading to the entire affected lower limb - the limb takes on a “forced” position, there is no movement in the limb. In some cases, the abscess can independently open onto the skin of the leg with a fistula, through which pus and parts of the bone (sequestra) drain - this is accompanied by an improvement in the patient’s condition and the transition of acute osteomyelitis to the chronic fistulous form.

Chronic osteomyelitis of the lower leg bones is characterized by the presence of a fistula in the lower leg area through which bone sequestra (parts of the lower leg bones destroyed by constant inflammation) emerge. As a result of constantly occurring purulent inflammation, the bone becomes fragile and so-called “pathological fractures” can occur - bone fractures that occur with minor injuries or even without them.

Treatment of osteomyelitis of the lower leg bones

Treatment of osteomyelitis of the leg is only inpatient. Suspicion of osteomyelitis is an indication for emergency hospitalization in the trauma department or purulent surgery department. Treatment is aimed both at eliminating the purulent process in the bone and at eliminating the distant source of infection. The treatment is complex and complex. Various types of limb immobilization, massive antibiotic therapy, surgical treatment - opening of a purulent source of infection, surgical prevention of the spread of infection are used.

Diagnosis of osteomyelitis of the lower leg bones

• surgeon consultation;
• consultation with a traumatologist;
• radiography of the leg bones;
• computed tomography of the lower leg bones;
• laboratory tests according to indications (general blood test, general urinalysis, biochemical blood test).

Osteomyelitis is a purulent-inflammatory process affecting the periosteum, compact and spongy substance, bone marrow - i.e. all elements of the bone. The occurrence of this disease is associated with the penetration of infection into the bone tissue, which enters there through the bloodstream (hematogenously) or from the outside due to various types of injuries. The incidence increases significantly during war years, when cases of gunshot wounds are common, but in peacetime doctors encounter it more than once.

Causes and epidemiology

Osteomyelitis is always caused by infection in the wound. 80% of cases of the disease are caused by staphylococcus, less often it is caused by streptococci and gonococci, as well as E. coli. As already mentioned, the infectious agent enters the wound hematogenously (spreads through the bloodstream from foci of infection of a different location to the bone) or from the outside due to injury.
More specifically, the causes of osteomyelitis can be:

• acute diseases caused by staphyllo-, strepto- or gonococcus (for example);
• foci of chronic infection (sinusitis, tonsillitis, caries, trophic ulcers, etc.);
• decreased immune status of the body;
• sudden changes in air temperature;
• work in extremely warm or cold conditions, dusty and gas-filled rooms;
• surgical interventions on bones for fractures.

Mechanism of disease development

1. The infectious agent enters the body from the outside (in acute diseases) or is present in it without causing significant symptoms (in chronic infections).
2. Against the background of decreased immunity, the bacterium enters the blood (this phenomenon is called bacteremia) and migrates throughout the body through the bloodstream.
3. At some stage, the bacteria settle on the bone, usually in the area of ​​the so-called neck of the bone, or metaphysis. Interestingly, the settling of a microorganism in the bone area does not at all guarantee the development of the disease: it may not develop at all or may appear after a few days or months.
4. At the site of entry of the pathogen, an abscess forms, which gradually spreads into the middle part of the bone - the diaphysis.
5. Due to inflammation, blood clots form in the bone vessels and, as a result, bone marrow necrosis occurs.
6. Through the Haversian canals, the pus spreads outward - under the periosteum, which gradually exfoliates - a subperiosteal abscess is formed.
7. The bone becomes necrotic, toxic metabolic products enter the blood, causing intoxication.
8. Pus inside the medullary canal causes an increase in pressure in it, which is manifested by severe pain at the site of inflammation.
9. In the absence of adequate treatment, pus gradually accumulates and, melting the periosteum (periosteum), breaks into the soft tissue - an intermuscular phlegmon is formed. At this point the pain becomes less intense.
10. Subsequently, the pus, melting the muscles, then the skin, comes out, and the disease becomes secondary chronic. On average, the period from the onset of the disease until the process becomes chronic is 3–12 weeks.

Classification

According to the method of penetration of the pathogen into the bone, they are distinguished:

1. hematogenous osteomyelitis - with blood flow;
2. post-traumatic osteomyelitis:
   • postoperative;
   • firearm;
   • actually post-traumatic (due to fractures).

The nature of the course of osteomyelitis also varies.

1. Spicy:
   • toxic form;
   • septicopyemic form;
   • local form.
2. Chronic:

• as an acute outcome, i.e. secondary chronic;
• primary chronic (has 3 forms: Brody's abscess, Ollier's albuminous osteomyelitis, Garre's sclerosing osteomyelitis).

Clinical picture of osteomyelitis

Common symptoms of all forms of osteomyelitis are:

• severe general weakness;
• sweating;
• fever;
• bursting pain in the area of ​​infection;
• local changes in the skin (it is hot to the touch, hyperemic, there is a slight swelling, which gradually increases; in the case of an abscess, the area is sharply painful on palpation; in the last stages of the disease, a fistula with purulent discharge is formed);
• muscle contracture in nearby joints.

In addition to the general features of the disease, each clinical form of osteomyelitis has its own course characteristics, which are presented below.

Acute hematogenous osteomyelitis

The most common form of the disease in peacetime. The overwhelming number of cases are children. Mostly long tubular bones are affected - up to 85%: femur (up to 40% of cases), tibia (up to 32%) and humerus (up to 10%).

Acute gunshot osteomyelitis

A feature of this form of the disease is that an isolated primary lesion does not form in the bone marrow, and inflammation immediately spreads to the entire thickness of the bone. A deep open infected wound allows pyogenic flora to enter bone fragments.

Chronic secondary osteomyelitis

Develops in the absence of adequate treatment of the acute process (both hematogenous and post-traumatic) 3–12 weeks after its onset. Diagnosed if the following symptoms are present:

• there is a purulent fistula;
• there are bone sequestra (cavities);
• the process continuously recurs.

If the inflammatory process transitions from acute to chronic, the patient’s well-being improves significantly, and the pain becomes less pronounced. Fistulas form in the area of ​​the infection, from which pus is released. From time to time the fistulas close, then the process repeats again. Relapse of chronic osteomyelitis clinically resembles the debut of the acute form of the disease, however, the symptoms of intoxication and pain are not so pronounced.

Primary chronic forms of osteomyelitis

• Brody's abscess. It is a limited area of ​​necrosis of cancellous bone. Diagnosed by x-ray - an abscess in the thickness of the bone tissue.
• Ollier's albuminous osteomyelitis. Protein fluid accumulates at the site of infection. The symptoms of the disease are mild, sequestration is rare and slow.
• Garre's sclerosing osteomyelitis. Clinically, the course is sluggish. Intermuscular phlegmon and fistulas do not form. The x-ray shows areas of sclerosis and foci of bone tissue destruction.

Complications of osteomyelitis

Complications of acute osteomyelitis are:

• sepsis;
• spread of phlegmon to nearby tissues.

There are frequent cases of complications of chronic osteomyelitis, the main of which are:

• formation of joint ankylosis;
• deformations of the affected bones;
• walls of fistula tracts;
• formation of bone defects, false joints, pathological fractures;
• amyloidosis of internal organs (heart, liver, kidneys) – with a long course of the disease.

Diagnostics

Based on the patient’s complaints, as well as data from the medical history (previous injury) and life (foci of chronic infection, severe illnesses indicating a reduced immune status), objective examination data (visual changes in the area of ​​the infection, pain on palpation of the affected area), the doctor a surgeon or traumatologist will suspect osteomyelitis and prescribe additional examination methods to confirm this diagnosis.

1. Complete blood count: signs of bacterial inflammation (leukocytosis - increase in the number of leukocytes, shift of the leukocyte formula to the left, increase in ESR).
2. X-ray of the affected area of ​​the bone. Changes on the radiograph appear 2 weeks after the start of the process.
3. Fistulography with a radiopaque substance – in the presence of fistulas.
4. Radiothermometry, thermography.
5. Radioisotope scanning.
6. Marrow puncture with bone marrow biopsy.

Treatment of osteomyelitis

Treatment of this disease is carried out exclusively by a specialist in a hospital setting.

In case of severe intoxication, the patient is recommended to undergo strict bed rest with immobilization of the affected area.

The food in the patient’s diet should be easily digestible, rich in vitamins and microelements. To reduce symptoms of intoxication, drinking plenty of fluids is recommended.

The primary treatment measure is sanitation of the affected area followed by local and systemic antibiotic therapy. At the initial stages, in order not to wait for the results of culture of purulent masses, broad-spectrum antibiotics are prescribed (cephalosporins - Cefix, Ceftriaxone, Zinnat; osteotropic antibiotics - Clindamycin, Lincomycin). When the culture results are known, the antibiotic is changed according to the sensitivity of the microorganisms to it.

Detoxification therapy plays an important role. The following solutions are administered to the patient: colloids (Polyglucin, Reopoliglucin) and crystalloids (saline solution); actual detoxification agents (Neocompensan, Hemodez, Neogemodez); in severe cases, plasmapheresis, hemosorption, ultraviolet or laser irradiation of blood are used.

Immunity correctors are also prescribed: Timalin, interleukins, gamma globulin, hyperimmune plasma, Levamisole, Sodium Nucleinate.

In parallel, therapy is carried out aimed at eliminating symptoms that are unpleasant for the patient:

• painkillers, anti-inflammatory, antipyretic drugs - ibuprofen, paracetamol, nimesulide, acetylsalicylic acid;
• correctors of heart failure - cardiac glycosides, ACE inhibitors, diuretics;
• correctors of water-salt balance and acid-base balance (sodium bicarbonate, Trisol, Disol, Acesol).

If conservative treatment of osteomyelitis does not have the desired effect within several days, they resort to surgical treatment: trephination of the bone, its revision (removal of pus), drainage, followed by regular washing with antiseptic solutions. Radical operations include sequesternecrectomy and bone resection. After careful removal of the purulent focus from the bone, it is possible to restore the length and shape of the bone using the Ilizarov apparatus.