Osteomyelitis of the finger. How to treat bone osteomyelitis? Causes, symptoms, diagnosis and folk remedies Nail osteomyelitis

Depending on the etiology of osteomyelitis, it is divided into nonspecific and specific (tuberculous, syphilitic, brucellosis, etc.); post-traumatic, hematogenous, postoperative, contact. The clinical picture depends on the type of osteomyelitis and its form (acute or chronic). The basis of treatment for acute osteomyelitis is the opening and sanitation of all ulcers, for chronic osteomyelitis - removal of cavities, fistulas and sequestration.

Osteomyelitis

Osteomyelitis is an inflammation of the bone marrow, which usually affects all elements of the bone (periosteum, spongy and compact substance). According to statistics, osteomyelitis after injuries and operations accounts for 6.5% of all diseases of the musculoskeletal system.

Most often it affects the femur and humerus, lower leg bones, vertebrae, mandibular joints and upper jaw. After open fractures of the diaphysis of long bones, post-traumatic osteomyelitis occurs in 16.3% of cases. Men suffer from osteomyelitis more often than women, children and the elderly - more often than young and middle-aged people.

Classification of osteomyelitis

There are nonspecific and specific osteomyelitis. Nonspecific osteomyelitis is caused by pyogenic bacteria: Staphylococcus aureus (90% of cases), streptococcus, Escherichia coli, and less commonly, fungi. Specific osteomyelitis occurs with tuberculosis of bones and joints, brucellosis, syphilis, etc.

Depending on the path by which microbes penetrate the bone, endogenous (hematogenous) and exogenous osteomyelitis are distinguished. In hematogenous osteomyelitis, pathogens of purulent infection are introduced through the blood from a remote focus (furuncle, felon, abscess, phlegmon, infected wound or abrasion, tonsillitis, sinusitis, carious teeth, etc.). With exogenous osteomyelitis, the infection penetrates the bone during injury, surgery, or spreads from surrounding organs and soft tissues.

In the initial stages, exogenous and endogenous osteomyelitis differ not only in origin, but also in manifestations. Then the differences are smoothed out and both forms of the disease proceed in the same way.

The following forms of exogenous osteomyelitis are distinguished:

post-traumatic (after open fractures);
gunshot (after gunshot fractures);
postoperative (after wires or bone surgeries);
contact (during the transition of inflammation from surrounding tissues).

As a rule, osteomyelitis is initially acute. In favorable cases it ends with recovery, in unfavorable cases it becomes chronic. In atypical forms of osteomyelitis (Brodie's abscess, Ollier's albuminous osteomyelitis, Garre's sclerosing osteomyelitis) and some infectious diseases (syphilis, tuberculosis, etc.) there is no acute phase of inflammation, the process is primarily chronic.

Acute osteomyelitis

Manifestations of acute osteomyelitis depend on the route of infection, the general condition of the body, the extent of traumatic damage to the bone and surrounding soft tissues. On radiographs, changes are visible 2-3 weeks after the onset of the disease.

Hematogenous osteomyelitis

As a rule, it develops in childhood, with a third of patients becoming ill before the age of 1 year. Quite rare cases of the development of hematogenous osteomyelitis in adults are actually relapses of the disease suffered in childhood. Most often it affects the tibia and femur. Multiple bone lesions are possible.

From a remote source of inflammation (soft tissue abscess, phlegmon, infected wound), microbes are carried through the blood throughout the body. In long tubular bones, especially in their middle part, a wide network of vessels is well developed, in which the speed of blood flow slows down. Infectious agents settle in the cancellous bone. Under unfavorable conditions (hypothermia, decreased immunity), microbes begin to multiply rapidly, and hematogenous osteomyelitis develops. There are three forms of the disease:

Septic-pyemic form. Characterized by an acute onset and severe intoxication. Body temperature rises to 39-40°, accompanied by chills, headache and repeated vomiting. Possible loss of consciousness, delirium, convulsions, hemolytic jaundice. The patient's face is pale, lips and mucous membranes are bluish, and the skin is dry. The pulse is increased, the pressure is reduced. The spleen and liver enlarge, and sometimes bronchopneumonia develops.

On the 1st-2nd day of the disease, precisely localized, sharp, drilling, bursting or tearing pain appears in the affected area, intensifying with the slightest movements. The soft tissues of the limb are swollen, the skin is hot, red, and tense. When it spreads to nearby joints, purulent arthritis develops.

After 1-2 weeks, a focus of fluctuation (fluid in the soft tissues) forms in the center of the lesion. Pus penetrates the muscles, intermuscular phlegmon is formed. If the phlegmon is not opened, it can open on its own with the formation of a fistula or progress, leading to the development of periarticular phlegmon, secondary purulent arthritis or sepsis.

Local form. The general condition suffers less and sometimes remains satisfactory. Signs of local inflammation of bone and soft tissue predominate.

Adynamic (toxic) form. Rarely seen. Characterized by lightning-fast onset. The symptoms of acute sepsis predominate: a sharp increase in temperature, severe toxicosis, convulsions, loss of consciousness, a pronounced decrease in blood pressure, acute cardiovascular failure. Signs of bone inflammation are weak and appear late, which makes diagnosis and treatment difficult.

Post-traumatic osteomyelitis

Occurs with open bone fractures. The development of the disease is facilitated by contamination of the wound at the time of injury. The risk of developing osteomyelitis increases with comminuted fractures, extensive soft tissue damage, severe concomitant injuries, vascular insufficiency, and decreased immunity.

Post-traumatic osteomyelitis affects all parts of the bone. In linear fractures, the area of inflammation is usually limited to the fracture site; in comminuted fractures, the purulent process tends to spread. Accompanied by hectic fever, severe intoxication (weakness, weakness, headache, etc.), anemia, leukocytosis, increased ESR. The tissues in the area of the fracture are swollen, hyperemic, and sharply painful. A large amount of pus is released from the wound.

Gunshot osteomyelitis

More often occurs with extensive lesions of bones and soft tissues. The development of osteomyelitis is promoted by psychological stress, decreased body resistance and insufficient wound treatment.

General symptoms are similar to post-traumatic osteomyelitis. Local symptoms in acute gunshot osteomyelitis are often mild. The swelling of the limb is moderate, there is no profuse purulent discharge. The development of osteomyelitis is indicated by a change in the wound surface, which becomes dull and covered with a gray coating. Subsequently, inflammation spreads to all layers of the bone.

Despite the presence of a focus of infection, with gunshot osteomyelitis, bone fusion usually occurs (the exception is significant bone fragmentation, large displacement of fragments). In this case, purulent foci end up in the callus.

Postoperative osteomyelitis

It is a type of post-traumatic osteomyelitis. Occurs after osteosynthesis operations of closed fractures, orthopedic operations, insertion of wires when applying compression-distraction devices or applying skeletal traction (wire osteomyelitis). As a rule, the development of osteomyelitis is caused by non-compliance with asepsis rules or a highly traumatic operation.

Contact osteomyelitis

Occurs due to purulent processes in the soft tissue surrounding the bone. Especially often, the infection spreads from soft tissue to the bone with panaritium, abscesses and phlegmon of the hand, and extensive wounds of the scalp. Accompanied by increased swelling, increased pain in the area of injury and the formation of fistulas.

Treatment of acute osteomyelitis

Only in hospital in the traumatology department. The limb is immobilized. Massive antibiotic therapy is carried out taking into account the sensitivity of microorganisms. To reduce intoxication, replenish blood volume and improve local blood circulation, plasma, hemodez, and 10% albumin solution are transfused. For sepsis, methods of extracorporeal hemocorrection are used: hemosorption and lymphosorption.

A prerequisite for successful treatment of acute osteomyelitis is drainage of the purulent focus. In the early stages, burr holes are made in the bone, followed by washing with solutions of antibiotics and proteolytic enzymes.

For purulent arthritis, repeated punctures of the joint are performed to remove pus and administer antibiotics; in some cases, arthrotomy is indicated. When the process spreads to soft tissues, the resulting ulcers are opened, followed by open rinsing.

Chronic osteomyelitis

With small foci of inflammation, complex and timely treatment, mainly in young patients, restoration of bone tissue prevails over its destruction. Foci of necrosis are completely replaced by newly formed bone, and recovery occurs. If this does not happen (in approximately 30% of cases), acute osteomyelitis becomes chronic.

By about 4 weeks, in all forms of acute osteomyelitis, sequestration occurs - the formation of a dead area of bone surrounded by altered bone tissue. At 2-3 months of the disease, the sequestra are finally separated, a cavity is formed at the site of bone destruction and the process becomes chronic.

Symptoms

As acute osteomyelitis transitions to chronic, the patient's condition improves. The pain decreases and becomes aching. Fistula tracts are formed, which may look like a complex system of canals and extend to the surface of the skin far from the site of injury. A moderate amount of purulent discharge is released from the fistulas.

During the period of remission, the patient's condition is satisfactory. The pain disappears, the discharge from the fistula becomes scarce. Sometimes the fistulas close. The duration of remission for osteomyelitis ranges from several weeks to several decades, depending on the general condition and age of the patient, localization of the lesion, etc.

The development of relapse is facilitated by concomitant diseases, decreased immunity and closure of the fistula, leading to the accumulation of pus in the resulting bone cavity. Relapse of the disease resembles an erased picture of acute osteomyelitis, accompanied by hyperthermia, general intoxication, leukocytosis, and increased ESR. The limb becomes painful, hot, red and swollen. The patient's condition improves after opening the fistula or opening the abscess.

Complications of chronic osteomyelitis

Chronic osteomyelitis is often complicated by fractures, formation of false joints, bone deformation, contractures, purulent arthritis, malignancy (malignant tissue degeneration). A constantly existing source of infection affects the entire body, causing amyloidosis of the kidneys and changes in internal organs. During the period of relapse and when the body is weakened, sepsis is possible.

Diagnosis of chronic osteomyelitis

Making a diagnosis of chronic osteomyelitis in most cases does not cause difficulties. To confirm, an MRI, CT or radiography is performed. To identify fistulous tracts and their connection with the osteomyelitic lesion, fistulography is performed.

Treatment of chronic osteomyelitis

The operation is indicated in the presence of osteomyelitic cavities and ulcers, purulent fistulas, sequestration, false joints, frequent relapses with intoxication, severe pain and dysfunction of the limb, malignancy, disruption of other organs and systems due to chronic purulent infection.

A necrectomy (sequestrectomy) is performed - removal of sequesters, granulations, osteomyelitic cavities along with the internal walls and excision of fistulas, followed by lavage drainage. After sanitation of the cavities, bone grafting is performed.

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Osteomyelitis of the hand

Osteomyelitis is a purulent infection that affects the bone tissue (ostitis), the periosteum surrounding the bone (periostitis) and the bone marrow (myelitis). Osteomyelitis that occurs for the first time is called acute. In the case of a long course of the disease with periods of exacerbation and remission, they speak of the development of chronic osteomyelitis.

Causes of osteomyelitis

Osteomyelitis develops when bacteria enter bone tissue, periosteum, or bone marrow.

Bone infection can occur through the endogenous (internal) route, when bacteria enter the bone tissue through the bloodstream through the blood vessels. Such osteomyelitis is usually called hematogenous (translated from Greek - generated from blood). Acute hematogenous osteomyelitis is more common in infancy, childhood and adolescence; adults rarely suffer from it.

Purulent inflammation of the bones can occur when microorganisms penetrate from the environment - this is exogenous osteomyelitis. An example of exogenous osteomyelitis is a bone infection that develops as a result of an open fracture, a gunshot wound, or after traumatic surgery (also called post-traumatic osteomyelitis). Another type of exogenous osteomyelitis is contact osteomyelitis, which occurs when purulent inflammation transfers to the bone from the surrounding soft tissues.

The main causative agents of hematogenous osteomyelitis are staphylococci and streptococci. In the case of post-traumatic osteomyelitis, several microorganisms are often detected simultaneously; Pseudomonas aeruginosa is often found.

Acute hematogenous osteomyelitis occurs after an infection such as tonsillitis (tonsillitis), inflammation of the middle ear, tooth suppuration, panaritium, furuncle and furunculosis, pyoderma (pustular skin diseases), omphalitis (inflammation of the umbilical ring), or after infectious diseases - measles, scarlet fever, pneumonia and others.

Post-traumatic osteomyelitis occurs after massive contaminated soft tissue injuries, open fractures, gunshot wounds, after surgical treatment of closed fractures using metal osteosynthesis (restoration of bone integrity with metal plates, knitting needles, screws).

Contact osteomyelitis occurs when infection spreads to the bone from surrounding soft tissues in the presence of purulent lesions (abscess, phlegmon).

The following conditions contribute to the development of osteomyelitis:

Alcohol abuse, smoking, intravenous drug use;

Varicose veins and chronic venous insufficiency;

Frequent infections (3-4 times a year), indicating a deficiency of the immune system;

Impaired kidney and liver function;

Malignant diseases (tumors);

Previous splenectomy (removal of the spleen);

Elderly and senile age;

Low body weight, poor nutrition.

Symptoms of osteomyelitis

Diagnosis of acute hematogenous osteomyelitis in the early stages is difficult.

General and local symptoms of the disease can be distinguished. The general picture of the disease, caused by the presence of bacteria in the blood (bacteremia), is as follows: after a short period of malaise, chills appear, the temperature rises from 37.5°C to 40°C, and the pulse quickens (above 90 beats per minute). At this stage, osteomyelitis can be mistaken for a common acute respiratory infection (for example, influenza).

On the 2nd - 3rd day of the disease, local signs appear in the form of local pain over the affected area, limited mobility and swelling of the soft tissues of the limb segment, and redness of the skin. The bones of the lower extremities (femur and tibia) are most often affected. Of the bones of the upper limb, the humerus is most often affected, followed by the radius and ulna. Less commonly, the bones of the hand and foot are involved in the process, as well as the ribs, spine, collarbone, pelvis, and shoulder blades.

In exogenous acute osteomyelitis, local signs of the disease come to the fore: the presence of a purulent wound, previous trauma and deformation of the contours of the limb, redness and increased temperature of the skin, swelling and tenderness of soft tissues to the touch, pain when moving in the affected area of the body. General symptoms are less pronounced and usually fade into the background.

With such symptoms, an abscess (a limited accumulation of pus in the soft tissues), phlegmon (a widespread purulent infection in the soft tissues), erysipelas, post-traumatic hematoma (local accumulation of blood) can be mistaken for osteomyelitis. These conditions also require emergency medical attention.

In the chronic course of the disease, the above symptoms are supplemented by previous osteomyelitis and the presence of fistulous tracts (round purulent wounds of small diameter on the skin, from which purulent discharge comes).

First aid for suspected osteomyelitis

Post-traumatic osteomyelitis develops some time (1 - 2 weeks) after injury, so it is important to properly treat the wound and consult a doctor in a timely manner. If you have received an extensive injury with a violation of the integrity of the skin, then the resulting wound should be washed with a soap solution and a 0.05% solution of chlorhexidine digluconate in order to mechanically remove microorganisms. The skin around the wound should be treated with a solution of brilliant green, and a sterile napkin (sold at the pharmacy) should be placed on the wound. A napkin can be soaked in a 3% hydrogen peroxide solution to stop bleeding. The limb should be immobilized. You can apply ice. Next, you need to go to the emergency room, where you will be examined by a traumatologist.

Traumatologists treat osteomyelitis that occurs after fractures, as well as metal osteosynthesis operations. In other cases (hematogenous osteomyelitis, contact osteomyelitis), you should seek help from a surgeon at the on-duty surgical hospital or a surgeon at the clinic.

Often, in the case of hematogenous osteomyelitis, patients end up in non-core departments, in particular, in infectious or therapeutic departments. However, after symptoms of bone damage appear, they are transferred to the surgical department.

Examination in hospital for suspected osteomyelitis

To diagnose osteomyelitis, you will need to undergo the following examination. Take a general blood and urine test, a blood test for glucose levels (to detect diabetes). If possible, you should donate blood for C-reactive protein, which is a sensitive indicator of the presence of inflammation.

In the presence of an open purulent wound or fistulous tract, a culture of the purulent discharge from them is performed in order to determine the pathogen and its sensitivity to antibiotics.

To visually confirm the presence of osteomyelitis, an x-ray of the affected area of the body is performed. However, it should be remembered that the X-ray picture of the disease lags behind the clinical one by 2 weeks, so in the case of acute osteomyelitis, there may not be obvious changes at the onset of the disease.

The figure shows a typical x-ray picture of osteomyelitis - a cavity in the bone, a pathological fracture.

It is possible to perform an ultrasound examination. It allows you to identify the accumulation of pus in soft tissues, the presence and extent of fistulous tracts, changes in the periosteum, and also evaluate the blood supply to the limb.

The most modern way to diagnose osteomyelitis is radionuclide diagnostics. The method is based on the use of radioactive pharmaceuticals, which specifically accumulate at the site of inflammation, which makes it possible to determine the presence of bone tissue destruction at an early stage. Unfortunately, this is an expensive test that requires high-tech equipment and special facilities, so it is only available in large medical centers.

Treatment of osteomyelitis

Treatment of osteomyelitis is complex, possible only in a hospital setting in a trauma or surgical department, and includes conservative and surgical measures.

Conservative treatment methods include:

Antibacterial therapy with broad-spectrum antibiotics - usually 2-3 drugs are prescribed (ceftriaxone, lincomycin, gentamicin) for a long time (3-4 weeks), replacing them with drugs from other groups (for example, ciprofloxacin, abactal, etc.);

Detoxification therapy (intravenous administration of saline solutions and plasmapheresis, procedures for ultraviolet and laser irradiation of blood - purification of blood plasma from toxins);

Immunotropic therapy - the use of pharmaceuticals that increase the activity of the immune system (polyoxidonium);

Prescription of probiotics – drugs that normalize intestinal microflora. Due to massive antibacterial therapy, dysbiosis develops. To correct it, Linex and Bifiform are prescribed;

Prescription of drugs that improve blood microcirculation (pentoxifylline, trental);

Local treatment of the wound - dressings with antiseptic ointments (levomekol, levosin, 5% dioxidine ointment) and proteolytic enzymes (trypsin, chymotrypsin), which help cleanse and heal the wound.

Surgical treatment of osteomyelitis consists of sanitation of the purulent focus (opening and drainage of purulent cavities), removal of sequesters - areas of non-viable bone tissue and performing reconstructive operations. The latter is necessary due to the formation of defects in the skin and bone tissue. Restorative operations include closing defects with local tissues, filling bones with various preparations, and performing osteosynthesis (for example, with an Ilizarov apparatus).

Osteosynthesis using the Ilizarov apparatus

There are no restrictions on diet after surgery. A nutritious diet rich in vitamins and proteins is necessary. The amount of physical activity should be discussed with your doctor individually. It is advisable to stop drinking alcohol and smoking - they slow down the wound healing process. If you have diabetes, you should monitor your blood sugar level; if it increases, a relapse of the disease is possible. In the postoperative period and after discharge from the hospital, physical therapy and physiotherapeutic treatment (electrophoresis, phonophoresis, magnetic therapy) are necessary.

Possible complications of osteomyelitis

Complications of osteomyelitis can be local and general.

Local complications include:

Abscess and phlegmon of soft tissues - accumulation of pus and purulent impregnation of the soft tissues surrounding the affected bone;

Purulent arthritis - purulent inflammation of the joint located next to the osteomyelitic lesion;

Spontaneous fractures - occur at the slightest load due to loss of bone tissue strength;

Contractures – impaired mobility due to the formation of scars in the muscles surrounding the purulent focus;

Ankylosis – loss of mobility in joints affected by purulent arthritis;

Development of malignant tumors.

General complications include:

Sepsis – blood poisoning;

Secondary anemia - anemia, develops due to suppression of hematopoiesis against the background of chronic inflammation;

Amyloidosis is an autoimmune disease that primarily affects the kidneys and is difficult to treat.

Prevention of complications of osteomyelitis

The incidence of complications and the likelihood of osteomyelitis transitioning to the chronic stage directly depends on the time of contacting a doctor. This is why it is so important to consult a specialist at the first signs of the disease. You should not self-medicate: if there is a purulent focus in the bone or soft tissues, it is necessary to drain the pus (perform surgery). Until this is accomplished, even the use of modern antibiotics will be ineffective.

As Arthur Schopenhauer said: “Health so outweighs all other blessings of life that a truly healthy beggar is happier than a sick king.” Therefore, take care of your health. It is better to overestimate the severity of your symptoms than to seek medical help late.

Osteomyelitis of the finger

Treatment of victims with hand injuries cannot be imagined without the use of restorative treatment methods - physiotherapy and therapeutic exercises. This is so indisputable that it does not require much proof.

With the development of wound infection on the hand and foot, more than with wound complications in other locations, delayed, secondary and repeated surgical treatment of wounds is indicated.

Osteomyelitis of the phalanges, metacarpal bones and carpal bones, as well as the bones of the foot, can develop both as a result of open injuries or gunshot wounds, and with poorly treated purulent processes in the soft tissues of the hand and foot that arise after microtrauma (felon, phlegmon).

Treatment of patients with osteomyelitis, purulent arthritis and osteoarthritis should be comprehensive and include active antibiotic therapy and the use of other antimicrobial chemotherapy drugs, complete and timely surgical intervention, complete immobilization and methods of rehabilitation treatment (physical therapy, physiotherapy, etc.).

The tactics and treatment plan for each patient are determined by the clinical picture and stage of development of the process. However, in all cases, the main element of complex therapy is surgery. When performing it, one must strive to achieve two goals: elimination of the osteomyelitic process and preservation of the segment of the hand or foot so that reconstructive interventions aimed at restoring their function are possible at the next stages of treatment.

For osteomyelitis or arthritis of the hand, targeted antibiotic therapy with intraosseous or intravenous administration of drugs under a tourniquet is highly effective, especially in the initial stages of development of the inflammatory process. At the same time, according to N.M. Vodyanov (1977), out of 75 patients with advanced osteomyelitis of the tubular bones of the hand, it was possible to eliminate the suppurative process using this method in only 3; wound healing occurred after the rejection of small sequesters.

72 patients underwent surgical intervention. Reamputation was performed in 32 people, sequestrectomy in 29, sequestrectomy followed by osteosynthesis in 2, sequestrectomy with arthrodesis in 2, sequestrectomy with wound closure with skin flaps in 6, bone resection in 2, sequestrectomy and phalangization of the first metacarpal bone with arthrodesis metacarpophalangeal joint - in 1 patient. In 90% of those operated on, the wounds healed by primary intention. One patient required repeat sequestrectomy and one patient required amputation of a finger.

Slit-like incisions for subcutaneous panaritium.

a - incisions on the distal phalanx; b - incisions on the middle and proximal phalanges

With purulent arthritis of the fingers, according to the same author, it was possible to stop the suppurative process in the joint by intraosseous administration of penicillin and streptomycin under a tourniquet, UHF therapy, and immobilization in 3 out of 23 patients; In 20 patients, surgical interventions were undertaken: opening and drainage of the joint - in 2, sequestrectomy and drainage - in 4, arthrodesis of the joint - in 10 (13 joints), amputation - in 4 patients. Drainage was carried out with vinyl chloride tubes, through which concentrated solutions of antibiotics were constantly administered.

In patients with common forms of osteoarthritis of the wrist, which arose after an open injury to the hand, sequestrectomy (in some with skin grafting) and intra-arterial or intravenous infusions of antibiotics under a tourniquet were used.

In case of bone panaritium, which has developed as a result of improperly treated and neglected subcutaneous panaritium, with the involvement of only one phalanx (limited marginal osteomyelitis), conservative therapy is possible - intravenous (intraosseous) infusions of antibiotics under a tourniquet, immobilization with a splint made of plaster or plastic “Polivik”. Such treatment can lead to an abortive course of the process. Most often, a limited sequestration is formed, which may go away on its own or require limited surgical intervention.

If the entire diaphysis of the phalanx is affected (diaphyseal osteomyelitis), a more radical operation is necessary, sometimes resection of the entire diaphysis.

The entire phalanx may be affected (total osteomyelitis), in which the entire phalanx is sequestered and must be removed.

Most often this is observed on the nail phalanx.

E.V. Usoltseva and K.I. Mashkara note that “the earlier a bone infection is recognized and the more distal the affected phalanx, the greater the chance of cure without additional surgery. In almost a third of patients, after thorough cleaning of the skin and wound and immobilization, there is no need for reoperation. The inflammatory process regresses - small sequestrations go away, the wounds clean and heal.”

To assess the effectiveness of conservative therapy, 5-7 days are usually sufficient. The absence of signs of improvement during the course of the disease dictates the need for surgery. For the incision, fistula tracts and wounds formed as a result of previous operations are used. The volume of resection is determined after exposure of the phalanx, depending on the extent of the destructive process in it. It should be emphasized that the operation is performed not only to sanitation a bone lesion, but also a soft tissue wound.

E.V. Usoltseva and K.I. Mashkara, in 20-25% of patients who operated on them for bone panaritium, pockets were found in the soft tissue wound, which were subjected to surgical treatment, where pus, pieces of necrotic tissue, nails, and rubber residues from drains were retained , bone “crumbs” and other bodies that support suppuration.

On the question of whether it is necessary to complete the operation in patients with bone panaritium by suturing the wound or whether it should be left open, there is no consensus among specialists in hand surgery. In cases where the wound is not sutured and heals by secondary intention, as a rule, a rough, inactive, often painful scar with impaired sensitivity is formed. Sometimes the scar sharply deforms the finger. After suturing the wound, the scar in the vast majority of patients is thin, mobile, painless and does not impair tactile sensitivity.

The time for wound healing and recovery of patients when the wound is sutured is significantly reduced. Nevertheless, most modern surgeons do not suture the wound, which is explained by the high risk of secondary wound suppuration and the possibility of exacerbation of the suppurative process. However, these fears should be considered exaggerated. In the work of V. A. Popov and V. V. Vorobyov, through a comparative analysis of the results of treatment of two large groups of patients with bone felons, the advantages of suturing the wound over open management were shown.

These advantages include a shorter treatment period, good functional results, and a high cure rate. The authors consider the impossibility of removing all necrotic tissue or the presence of a large residual cavity, or intolerance to antibiotics as contraindications to the application of a blind suture.

We do not dwell on the treatment of subcutaneous and tendon felons, purulent tenobursitis of the 1st and 5th fingers, since these issues are beyond the scope of our topic and are quite well reflected in the modern literature on purulent diseases of the hand area. We only note that when operating for subcutaneous panaritium, one should be guided by the principle: make an incision directly above the purulent focus, as shown in the figure borrowed from the book by E.V. Usoltsev and K.I. Mashkar.

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Bone panaritium

Rice. 22. Osteomyelitis of the diaphysis of the middle phalanx of the index finger in the sequestration phase (schematic drawing from an x-ray).

a - before surgery; 6 - after sequestrotomy; c - treatment outcome after 4 months.

This is tension in the soft tissues of the finger. Later, redness and swelling and general malaise appear, sometimes with an increase in body temperature.

Rice. 23. Outcome of osteomyelitis in patient G.

a - deformation of the hand and third finger, limitation of function; b - diagram from the radiograph - deformation of the proximal phalanx of the third finger, synostosis of the II and III carpometacarpal joints.

Only after making sure that the treatment is complete, i.e., that there are no areas of necrosis, granulations, small bone fragments, notches and foreign bodies in the bone and soft tissues, does bleeding stop and hemostasis is ensured. The bone wound is covered with periosteum or aponeurosis, sometimes strengthened with one or two sutures, or a hemostatic sponge is placed. The skin is cleaned of traces of blood and tanned with alcohol. An aseptic bandage is applied to bring the edges of the wound closer together. The arm is placed in a pre-prepared plaster splint. If possible, drains and drains are not inserted into the wound.

Rice. 24. Disfigured tip of the first finger with an ingrown nail and numerous retracted, painful scars after osteomyelitis of the distal phalanx.

And this operation did not provide sufficient cleanliness of the bone and outflow of discharge; the process progressed and was complicated by dorsal subaponeurotic phlegmon, lymphangitis, and osteoarthritis of the carpometacarpal joint. Hospitalization.

Trophic disorders 10.1

Painful disfiguring scars 9.8

Complications of other types of purulent infection 19.5

Combined complications 39.4

Surgery for diseases and injuries of the hand

The role of auxiliary factors in the rehabilitation of patients

Issues of rehabilitation after diseases and injuries of the hand

Phlegmon of the hand

Pandactylitis

Osteomyelitis of the finger

There are only 230 joints in the human body. The largest of them are the hip, the smallest are the interphalangeal. Over time, a person begins to be bothered by such a thing as joint pain. It can be exhausting and unbearable. Why does my whole body hurt? Only a specialist can answer this question. Often this phenomenon indicates a serious deviation. Prerequisites include age, gender, heredity, and bad habits. People over 50 begin to suffer from similar phenomena due to degeneration and tissue destruction. The female gender is more susceptible to pathology. During menopause, female hormones cease to be produced properly, resulting in a deficiency of calcium and other microelements. Bones become brittle and brittle. Heredity plays an important role, for example, if a grandmother, grandfather, mother, father had sick joints in the family, then the future generation may develop problems over time.

Bad habits such as smoking and alcohol make the body vulnerable to various types of infections; a person suffers more from stress and environmental conditions.

Causes

The main sources of why all joints of the body hurt and the reasons are as follows:

arthritis (including rheumatoid);
osteochondrosis;
gout, psoriasis;
bursitis, tendonitis;
infectious diseases;
pathologies of internal organs;

Physical inactivity or limited movement, yes, like the first factor, causes pain in all joints. Injuries, bruises, sprains and tendons, intoxication, excess weight, long-term use of glucocorticosteroids, osteoarthritis, ankylosing spondylitis.

Localization of pain

According to the variety, joint pain occurs in;

Let's look at each in more detail, as well as the causes of the disease and treatment.

Watch Dr. Bubnovsky's video about joint pain

Clavicular

Harbingers of problems with the acromioclavicular joint will be inflammation, redness of the area, and swelling under the bone. The sources of the phenomenon are injuries, bruises, fractures, dislocations, osteochondrosis, arthritis, radiculopathy, compression of the cervical roots, periarthritis of the shoulder blade. A broken bone, as a rule, swells, hemorrhage, redness, and increased temperature of the lesion begin. The displacement of the periosteal joint is visible from the side; it protrudes from above. The patient cannot move his arm to the side, and key syndrome is observed.

Acute with a fracture, flying pain in the joints with arthritis, radiculitis, rheumatism, neuralgia. Periarthritis is divided into mild, acute and severe. The initial stage practically does not bother the person; the acute stage is accompanied by fever, swelling of the collarbone, redness, and increases at night. In the chronic phase, the patient suffers from prolonged joint pain.

Brachial

Circumstances contributing to the malaise will be tendinitis, bursitis in the subacromial ligament. Symptoms: redness, pain in muscles and joints, discomfort on palpation, swelling, hemorrhage. Bacterial infections tuberculosis, osteomyelitis, candidiasis, streptococcus, chlamydia are always accompanied by fever and an acute course. Additionally, joint pain is provoked by arthrosis, brachial neuritis, and scapular periarthritis. Myocardial infarction, angina pectoris, excessive physical activity, salt deposits, osteochondrosis, intervertebral hernia.

Aching due to inflammation of the joint membrane. Drawing in case of hemorrhage in the muscles. Acute bursitis, tendonitis, osteochondrosis, periarthritis.

Elbow

Factors influencing the development of pathology include dislocations, diffuse fasciitis, pinched nerve endings, bursitis, chondromatosis, arthritis. Dislocations lead to tissue swelling, compactions, bursitis and arthritis provoke bumps on the elbows, the diameter can increase up to 10 cm, the area becomes red and hot to the touch.

Burning with bursitis, constant, increasing after physical activity with arthrosis. Aching, aching with arthritis, frequent rupture of ligaments and tendons.

Radiocarpal

The prerequisites for joint pain in the wrist are compression of the nerve fiber, tissue degeneration, synovitis, osteoarthritis, arthritis, osteochondrosis, tenosynovitis, fractures and sprains. If there is a blow to the wrist, resulting in a crack in the bone or fracture, the area quickly swells, turns red, damage to blood vessels leads to hematoma, and it becomes impossible to move the arm. Arthritis and other degenerative conditions of tissues and bones manifest themselves in the form of stiffness in the morning, swelling, focal temperature, uric acid deposits, kidney and heart damage.

The hand is divided into:

These are degenerative changes in cartilage and joint mass, infectious diseases, and autoimmune diseases. For example, arthritis in a severe phase leads to stiffness of the entire phalanx, and soreness of the fingers is observed. They are twisted, a person cannot even straighten them. Uric acid deposits lead to enlarged bones and deformation.

High with a crack, severe bruise, broken bone. Aching, unbearable with arthritis, osteoarthritis. Severe in osteoarthritis with increased discomfort during exercise. Quiets in a state of rest.

Hip

Reduced movement and shortening of one leg is caused by dislocation or subluxation. Moreover, sometimes this condition is called dysplasia, that is, congenital dislocation. Arthritis, bursitis, tendinitis are accompanied by inflammation, increased temperature of the area, redness, and hyperemia.

Sharp for subluxations, cracks, fractures. High in dystrophic disorders of the femur, with swelling after movements, at night. Rapid deterioration due to infection with increased sensations after exercise.

Knee

It may hurt due to falls on the leg, damage to the meniscus, gonarthrosis, gonarthritis, periarthritis, coxarthrosis. Signs of a strong blow will be bruises and hematomas. The knee swells, the damaged area changes color, and the temperature of the lesion increases. Tendon pathologies are detected by pain on the inside of the leg, which is especially hampered by climbing stairs, long walking, and physical exercise.

Drawing, moderate with bruise. Strong, with influxes due to meniscopathy, also subsides suddenly. Coxarthrosis is practically asymptomatic, only reflected pain appears in the femoral area.

Ankle

The culprits are considered to be subluxations, gout, arthrosis, fractures of the talus, metatarsal bones, arthritis, etc. and rheumatoid, rheumatism. Subluxations are characterized by the inability to fully move, a hot area, redness, and swelling. A fracture reveals itself through attacks of acute pain and complete loss of ability to stand on a limb. Arthritis provokes stiffness, especially in the morning; inflammation, infectious and reactive arthritis begins rapidly with an increase in temperature and deterioration of the patient’s condition.

Acute in case of trauma, high in arthritis, increasing in gout attacks. The latter in its severe stage is so painful that it causes severe discomfort at night.

Maxillary

When asked why the joints of the jaw apparatus hurt, one can suspect neuralgia or neuralgia of the laryngeal nerve. It occurs infrequently, but the attack lasts up to 3-5 minutes, along with cough, dry mouth, and oral spasms. Carotinidia or a migraine attack provokes joint pain and muscle spasms. Erythrootalgia comes along with edema, swelling, and disturbances in the volume of blood vessels. Infectious diseases occur in combination with an increase in temperature, and the lymph nodes become enlarged. A disorder of the function of the temporomandibular bone is characterized by a grinding or clicking sound that the patient hears when moving the jaw or chewing. Additionally, after influenza, ARVI, and colds, arthritis may develop, accompanied by fever, malaise, and general weakness. Subsequently, the muscles atrophy.

Neuralgia - burning, pulsating. Neuralgia of the laryngeal, glossopharyngeal nerve endings - paroxysmal, with pulsation. A bruise, a dislocation, a fracture—sharp, unbearable. With carotinidia, sharp pain continues in waves and lasts up to 2 hours. Temporal arteritis is severe; part of the face and neck may become ill.

Pregnancy

The causes of pulling sensations in the joints can lie not only in pathologies of the body, but also appear during pregnancy, after it, and menopause. So why do joints hurt when a woman is pregnant? Due to the additional stress that the female body experiences, a pulling, girdling aches manifests itself, as a rule, in the hip joint and lower back. An increase in body weight puts stress on the tummy, especially for mothers suffering from osteochondrosis. The 3rd trimester of pregnancy is caused by swelling, first the small joint tissues of the phalanx of the fingers, ankle, wrist, and hands are affected. Strong pressure causes dull pain, numbness, and weakness. Lack of calcium, increased production of relaxin, organ pathologies, symphysitis are a few more preconditions for the disease. Symphysitis is a common complication. Symptoms are dull, pulling sensations in the pubic area, clicking sounds when walking, difficulty raising limbs in a supine position.

For a long period of time, the body was not fully replenished with useful substances and microelements, which gave impetus to the development of a dormant disease. 9 months of gestation are difficult, especially when the baby grows large, subsequent worries put stress on the legs and spine.

Climax

What causes joint pain during menopause? The main source is a decrease in the production of sex hormones, estrogens. Calcium deficiency begins in the bones, they collapse, become brittle and brittle. Additionally, menopause leads to irritability, migraines, weakness, general fatigue, ebbs and flows, and increased heart rate. It is at this time that frequent fractures occur due to falls. Lack of estrogen contributes to the occurrence of osteoporosis, deforming osteoarthritis.

Why does the bones ache at the same time?

This often occurs in older people when the weather changes. It seems that every bone is being twisted, which is why it sometimes makes it difficult to sleep at night. If joints throughout the body hurt and ache, then physical strain is likely. The muscle area covers nearby areas. The condition why all joints hurt at the same time speaks of tissue tumors, osteomyelitis, malignant, benign processes, tuberculosis.

Treatment

Based on the diagnosis, the attending physician prescribes appropriate treatment. For mechanical damage, non-steroidal medications Analgin, Ibuprofen, Diclofenac, Ketoprofen. Anti-inflammatory ointments Voltaren, Indomethacin, warming Capsicam, Fastum gel. Compresses with Dimexide. Overlays with Dimexide and Novoican are used if a hematoma or severe swelling is observed with pain in the joints. Sometimes Analgin is added to this treatment regimen. The swelling resolves faster. Physiotherapy procedures with laser, heat, magnet. Cold bandages on the lesion.

Degenerative joint diseases include NSAIDs Piroxicam, Nimesulide, Ketorolac, Diclofenac. Injections in ampoules of Diprospan, Flosteron, Metipred. Ointments Arthrocin, Dolgit, Chondroxide. Honda protectors Arthra, DONA, Structum are prescribed. The latest development for joint pain is “Chinese” patches. They act only locally, without any side effects on the body. Thanks to the natural composition, allergic reactions are minimized. Absorption of substances occurs quickly, the duration of use contributes to deep penetration into the tissue layers.

Proper nutrition is important for pain and aches in the joints. You need to eat food enriched with calcium, magnesium, and potassium. Systematically consume vitamin complexes. Laser therapy, ultrasound, magnet, electrophoresis, physical therapy, and massage provide a good outcome. Severe forms are treated surgically when conservative treatments do not help. Part of the affected joint is excised using arthroscopy, and sometimes endoprosthesis replacement is used.

Estrogen is replaced with hormone replacement therapy. Medicines are produced both in the form of Angelique, Klimen, Divina, Primarin pills, as well as suppositories, creams, and hormonal patches. If it is impossible to treat with hormones, then the specialist will prescribe herbal medicines Remens, Klimaksan, Estrovel, Klimadinon. Supplements containing calcium Vigantol, Aquadetrim, Natekal, Nycomed, Kaltsinova are required.

What to do at home?

If you fall on your arm or leg, apply cold to the sprain or bruise. Take painkillers analgesics Ibuprofen, Nise, Analgin. Grandmother's rub is good for relieving rheumatoid syndromes. It will require 300 ml of alcohol, 10 ml of camphor alcohol, 10 ml of iodine solution, 10 analgin tablets. All ingredients are mixed and infused for at least 21 days. Then the resulting drug is carefully rubbed into the area overnight, and a scarf or handkerchief is tied on top. The course is about 10 days.

It is necessary to finely grate the root and apply it to the problem area. Tie the top with cotton or linen fabric. Walk with the bandage for 2 hours. If the burning sensation is severe, the roots are replaced with leaves. The regimen is the same.

Practice has shown that systematic use of gelatin alleviates ailments in the limbs. The product is based on collagen, which is obtained from animal cartilage and bones. Collagen perfectly nourishes cartilage and joint contents. Increases their elasticity and strength. The disadvantage is the duration of treatment, about 2 months.

Despite the fact that fly agaric is considered to be a poisonous mushroom, it can treat diseases of the musculoskeletal system. The ointment is made from dried mushrooms; fresh mushrooms and Vaseline will also work. The drug is rubbed into the area. The tincture is prepared from crushed fungi and alcohol. Store in a dark, cool place. Course from 7 days.

When do you need a doctor's help?

If your joints hurt badly, what should you do in this situation? There is no need to delay visiting the doctor. Any manifestations in the form of temperature, severe discomfort, fever, large swelling, hemorrhage serve as a reason for examination. Persistent pain after a fall requires consultation with a doctor in order to avoid suspicion of a fracture and complications.

In conclusion, I would like to say that only a specialist can recognize the true source of the disease, because many symptoms are similar to each other.

Treatment of tenosynovitis of the wrist and elbow joint

Tenosynovitis is an inflammatory process of the inner membrane of the tendon of the fibrous sheath muscle, namely the synovial membrane, which helps facilitate sliding in the osteofibrous canals of the corresponding tendon during muscle work.

Causes of the disease
Symptoms of the disease
Complications of the disease
- Local treatment
- Physiotherapeutic treatment

Tenosynovitis is classified into chronic and acute. An acute disease is manifested by the accumulation of a large amount of fluid in the area of the synovial membrane and its swelling.

Chronic joint disease is accompanied by accumulation of effusion in the synovial cavity with an increased amount of fibrin and thickening of the synovial membrane. After a certain time, as a result of fibrinous effusion, the cavity of the tendon sheath narrows, and so-called “rice bodies” are formed.

Taking into account the nature of the inflammation, purulent, serous-fibrinous, and serous tendovaginitis are distinguished.

Causes of the disease

Taking into account the causes of joint disease, the following groups of tendovaginitis can be identified.

Aseptic independent tendovaginitis, the appearance of which is the result of prolonged microtraumatization and strong tension of the synovial sheaths of tendons and adjacent tissues of the joints in people of certain professions (mechanics, carpenters, typists, loaders, hosiery makers, pianists, heavy industry workers, molders) who work for a long time identical movements where a specific muscle group is involved. In addition, these tendovaginitis can develop in athletes (skaters, skiers, etc.) during intense training.

reactive tendovaginitis, their development is accompanied by rheumatic diseases (ankylosing spondylitis, rheumatism, systemic scleroderma, rheumatoid arthritis, Reiter's syndrome, etc.);
nonspecific tendovaginitis during purulent processes (osteomyelitis, felon, purulent arthritis), which results in direct spread of inflammation to the synovial vagina;
specific forms of the disease during certain infectious diseases (such as tuberculosis, brucellosis, gonorrhea, etc.), when the spread of pathogens most occurs hematogenously (with blood circulation).

Symptoms of the disease

Nonspecific acute tenosynovitis of the wrist joint is characterized by a sharp onset and rapid appearance of swelling in the area where the infected tendon sheaths of the synovial membranes are located. As a rule, acute tenosynovitis affects the tendons of the dorsal surface of the hand, less often it forms in the synovial sheaths of the finger flexor tendons and in the hand.

Pain and swelling of the joint usually spreads from the hand to the forearm. Restrictions of movement may appear, and flexion contracture is likely to develop on the fingers of the hand. If the inflammation process is purulent in nature, then the symptoms may be as follows:

lymphangitis develops (inflammation of the lymph vessels) and regional lymphadenitis (lymph nodes enlarge as a result of inflammation);
chills appear;
General body temperature increases rapidly.

Purulent tendovaginitis, as a rule, appears in the area of the hand on the flexor tendon sheaths.

Aseptic acute tenosynovitis is characterized by disease of the synovial sheaths on the back surface of the hand, and sometimes the foot. At the beginning of the disease, it occurs in an acute form: swelling appears in the area of the diseased tendon, and when palpated, crepitus (crunching) is felt. There is pain when moving or limited movement of the finger. May become a chronic form of the disease.

Chronic tendovaginitis is characterized by damage to the sheaths of the extensor and flexor tendons of the fingers in the area of their retinaculum. Often there are signs of chronic tendovaginitis of the flexor fingers of the common synovial sheath, which are called carpal tunnel syndrome; with this lesion, a painful, elongated tumor-like formation appears in the area of the carpal tunnel, often taking on the contours of an hourglass and having an elastic consistency, slightly shifting during movement. Sometimes you can identify fluctuation (the sensation of a passing wave, which is explained by the accumulation of fluid) or feel for “rice bodies”.

There is a separate form of chronic tenosynovitis, which is called de Quervain's tenosynovitis or stenosing tenosynovitis, which is characterized by damage to the tendon sheath of the abductor pollicis longus muscle and the flexor brevis muscle. With this form, the walls of the vagina thicken, and, accordingly, the gap of the synovial vagina narrows. De Quervain's tenosynovitis is characterized by pain in the area of the styloid process of the wrist joint, which often radiates to the elbow or first finger, as well as swelling. The pain intensifies when a person presses the first finger to the surface of the palm and bends the other fingers above it.

Tuberculous tenosynovitis of the joint is characterized by the appearance of dense formations (“rice bodies”) in the process of increasing the size of the tendon sheaths.

Complications of the disease

Radiation purulent tenobursitis is most often considered a complication of the thumb with purulent tenosynovitis. Appears when purulent inflammation spreads to all the tendons of the thumb to the long extensor of the hand. It is characterized by severe pain along the surface of the palm of the thumb and further along the outer edge of the hand to the forearm. If the disease progresses, then the purulent process is likely to transfer to the forearm.

Ulnar purulent tenobursitis is most often considered a complication of the little finger of the hand with purulent tenosynovitis. Due to the specific anatomical structure, the process of inflammation can often move from the synovial sheath of the little finger to the common flexor of the hand, and less often to the long flexor of the thumb. In this case, the so-called cross phlegmon begins to develop; it is characterized by a severe progression of the disease and is often complicated by the work of the hand.

Carpal tunnel syndrome: Its clinical appearance and development is attributed to compression of the median nerve in the carpal tunnel. Characterized by a feeling of numbness and sharp pain, crawling sensations in the area of the I-III fingers, tingling. The sensitivity of the tips of these fingers decreases, and the strength of the muscles in the hand decreases. The pain intensifies at night, leading to sleep disturbances. A slight relief is likely to occur when waving your hand or lowering it down. Very often there is a change in the color of the skin of the affected fingers. There is likely a local decrease in pain sensitivity and increased sweating. When palpating the wrist, pain and swelling are detected.

Forced raising of the arm and flexion of the hand can cause aggravation of paresthesia and pain in the area of innervation of the central nerve. Often, carpal tunnel syndrome occurs simultaneously with Guyon's canal syndrome; it is quite rare to encounter it independently. During Guyon's canal syndrome, due to the fact that the elbow nerve is compressed in the area of the pisiform bone, tingling sensations, a feeling of numbness and pain appear, swelling in the area of the pisiform bone, crawling in the 4th and 5th fingers, as well as pain when palpating from the palm .

Laboratory diagnostics and examination

Determination of tenosynovitis is made possible by the data obtained during a clinical examination and the characteristic localization of the pathological process.

During a laboratory test for purulent acute tenosynovitis, a blood test determines leukocytosis, an increase in the erythrocyte sedimentation rate, and an increase in the number of band forms of neutrophils (more than 6%). The pus is examined by bacteriological (examination of clean liquid) and bacterioscopic (examination under a microscope after staining) methods, which makes it possible to identify the cause of the pathogen and find out its sensitivity to drugs.

In cases where the course of purulent acute tenosynovitis is complicated by sepsis, then a blood test is performed for sterility, which also makes it possible to determine the nature of the pathogen and its sensitivity to antibiotics.

Treatment of tenosynovitis of the wrist joint

Treatment of tenosynovitis of the hand is divided into local and general. Treatments for septic and aseptic forms of the disease differ.

General treatment of tenosynovitis of the hand

Treatment of the infectious acute form of nonspecific tenosynovitis involves the use of drugs that are designed to destroy the infection. For starters, these are antibacterial agents, as well as drugs that increase immunity.

Treatment of infectious tendovaginitis is carried out taking into account the underlying disease. That is, drugs are used that are designed to combat this disease.

The treatment strategy for aseptic tenosynovitis is based on the use of non-steroidal anti-inflammatory drugs.

Local treatment

At the initial stage of treatment, local therapy of any form of the disease is designed to organize the rest of the diseased hand. In addition, if there are no contraindications, the doctor may prescribe the application of hot compresses, which are designed to relieve pain.

In cases where a purulent process occurs, the tendon sheath is opened, drained and washed.

During a specific form of tenosynovitis, local therapy may differ. For example, when determining the tuberculous nature of the disease, a solution of streptomycin is injected into the affected area.

Physiotherapeutic treatment

As the acute symptoms of the disease subside, doctors advise adding physical therapy treatment. The following procedures are considered the most effective:

microwave therapy;
use of ultraviolet light;
electrophoresis with hydrocortisone and novocaine;
ultrasound therapy.

During the chronic form of the disease, the range of treatment is different. The most effective in this case:

lidase electrophoresis;
physiotherapy;
massage;
ozokerite applications.

The causes of occurrence, treatment tactics and clinical manifestations of tenosynovitis differ depending on the form of the disease, therefore only a professional rheumatologist who can diagnose the form and prescribe effective and adequate treatment of the disease must deal with treatment. If treated promptly, tenosynovitis has a favorable prognosis. But with purulent tendovaginitis, persistent dysfunction of the affected hand can often remain.

What is characteristic of de Quervain's disease - symptoms and treatment

De Quervain's disease (tenosynovitis) is a syndrome characterized by inflammation of the tendons of the thumb.

With this disease, friction occurs between the swollen tendons and their sheaths against the narrow tunnel in which they move, resulting in pain in the base of the first finger.

To understand the process, we will briefly describe the anatomy of hand movements.

Contraction of the muscles of the forearm provides flexion and extension of the fingers. The transmission of muscle contraction to the fingers and their movement is carried out by the tendons of the flexor and extensor muscles.

The tendons of the flexor muscles pass to the fingers through the palmar surface of the hand, and the extensor muscles through the dorsum.

The tendons are held in the desired position on the hand by the transverse ligaments. On the back of the hand is the dorsal ligament. Each group of tendons in the dorsal carpal ligament is in a separate canal.

For example, in the first fibrous canal there are tendons that go to the first finger of the hand.

Simply put, de Quervain's tenosynovitis causes inflammation of the ligaments, swelling and thickening. As a result, the channel for the ligament becomes too small, symptoms of the disease arise, and the function of the entire hand is impaired.

Where are the true causes of the syndrome?

There is no exact cause that causes tenosynovitis.

However, it is believed that activities that involve constant, repetitive hand movements, such as golfing, gardening, or carrying a child, can worsen the condition.

This is why this disease is sometimes called “gamer’s thumb” or “mother’s wrist” abroad.

Possible causes of the disease:

hand injuries, since as a result of injuries, scar tissue is formed that can limit the movement of the tendon;
inflammatory diseases of the joints;

Risk factors

People between the ages of 30 and 50 are at greatest risk of developing the pathology, mostly women. This may be due to pregnancy and caring for a newborn, and repeated lifting of the child.

Signs of illness

De Quervain's disease has characteristic symptoms:

pain at the attachment point of the base of the thumb;
swelling at the base of the thumb;
Difficulty moving the wrist when performing everyday activities;
the pain intensifies when pressing on the affected area.

In the initial stages of the disease, pain appears only when the thumb is forcibly extended and when sudden and intense movements of the hand are made.

Over time, the pain becomes constant or occurs even with the slightest movements.

The pain may radiate to the hand, shoulder, forearm and neck area. Sometimes the pain spreads along the back of the thumb to its tip.

Sometimes night pain occurs when, during sleep, some awkward movement causes a sharp pain in the hand. Patients are also characterized by reduced grip strength on an object with the affected hand.

If the syndrome is not treated for a long time, the pain may spread to the forearm. Any movement that requires the participation of the thumb will cause pain, which leads to decreased ability to work.

Diagnostic techniques

Diagnosis of the disease is based on samples and tests:

Filkenstein test. The first finger of the hand is squeezed inside the fist and the hand is abducted in the direction of the little finger or thumb. If sharp pain occurs in the wrist joint on the side of the first finger when the hand is abducted, the test is considered positive.
Tense abduction test. When pressing from the back side on the thumb of the hand so that the finger is brought to the palm, on the sore side, even with slight pressure on the finger, a sharp pain will occur, and the finger will be brought to the palm practically without resistance, and on the healthy hand the finger will be vigorously resist pressure.
Testing the ability to hold objects using the thumb. The patient tries to hold an object between the thumb and index finger with the sick and healthy hand. When you try to pull a held object, it becomes clear that the affected hand holds the object much weaker. When trying to hold an object removed from the affected hand, a sharp pain occurs in the wrist joint in the area of the thumb.
X-ray examination. In the initial stages of the disease, x-rays reveal a twofold thickening of the soft tissues. With a long course of the disease, signs of changes in the bone and periosteum in the wrist joint in the area of the thumb are visible.

Healing procedures

Treatment of de Quervain's syndrome is possible conservatively and surgically.

Conservative treatment

First of all, patients stop doing physical activity.

The affected ligament is immobilized so that the first finger is in a bent position and located opposite the second and third fingers, the hand itself should be slightly bent to the back.

Therefore, for immobilization, a plaster cast is used, applied from the fingertips to the middle of the forearm.

Refusal of physical activity and immobilization prevent further injury to the joint, but this is not a cure.

Over the next two to three weeks of keeping the arm in a plaster cast, it is necessary to carry out adequate conservative therapy for the disease.

The disease is based on the inflammatory process of the ligament, so physiotherapeutic procedures, anti-inflammatory drugs and novocaine blockades are used to treat tendons.

However, these drugs are not very effective for long-term disease, and quite often after a short period of remission the disease occurs again.

Local injections of hydrocortisone have a good anti-inflammatory effect; they are administered two to six times with a break of two to three days.

Conservative treatment is always followed by a rehabilitation period lasting from two to four weeks.

Surgical treatment of pathology

If conservative treatment is ineffective, surgical treatment of de Quervain's disease is often resorted to. For bilateral lesions, surgical treatment is also indicated.

The operation can also be performed on an outpatient basis using local anesthesia. During the operation, the ligamentous canal is dissected and the tendon compression is released.

Possible complications

Therefore, if symptoms of the disease occur, you should immediately consult a doctor.

With surgical treatment, there is a small chance of complications such as the formation of a painful scar and impaired movement of the thumb.

Preventive measures

To reduce the likelihood of the syndrome occurring, it is necessary to reduce physical activity associated with repetitive twisting and grasping movements of the hand.

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– inflammation of the bone marrow, which usually affects all elements of the bone (periosteum, spongy and compact substance). Depending on the etiology of osteomyelitis, it is divided into nonspecific and specific (tuberculous, syphilitic, brucellosis, etc.); post-traumatic, hematogenous, postoperative, contact. The clinical picture depends on the type of osteomyelitis and its form (acute or chronic). The basis of treatment for acute osteomyelitis is the opening and sanitation of all ulcers, for chronic osteomyelitis - removal of cavities, fistulas and sequestration.

General information

(from Latin osteon bone + myelos bone marrow + itis inflammation) – inflammation of the bone marrow, which usually affects all elements of the bone (periosteum, spongy and compact substance). According to statistics, osteomyelitis after injuries and operations accounts for 6.5% of all diseases of the musculoskeletal system. Most often it affects the femur and humerus, lower leg bones, vertebrae, mandibular joints and upper jaw. After open fractures of the diaphysis of long bones, post-traumatic osteomyelitis occurs in 16.3% of cases. Men suffer from osteomyelitis more often than women, children and the elderly - more often than young and middle-aged people.

Classification

post-traumatic (after open fractures);
gunshot (after gunshot fractures);
postoperative (after wires or bone surgeries);
contact (during the transition of inflammation from surrounding tissues).

As a rule, osteomyelitis is initially acute. In favorable cases it ends with recovery, in unfavorable cases it becomes chronic. In atypical forms of osteomyelitis (Brodie's abscess, Ollier's albuminous osteomyelitis, Garre's sclerosing osteomyelitis) and some infectious diseases (syphilis, tuberculosis, etc.), there is no acute phase of inflammation, the process is primarily chronic.

Acute osteomyelitis

Local form. The general condition suffers less and sometimes remains satisfactory. Signs of local inflammation of bone and soft tissue predominate.

Adynamic (toxic) form. Rarely seen. Characterized by lightning-fast onset. The symptoms of acute sepsis predominate: a sharp increase in temperature, severe toxicosis, convulsions, loss of consciousness, a pronounced decrease in blood pressure, acute cardiovascular failure. Signs of bone inflammation are weak and appear late, which makes diagnosis and treatment difficult.

Post-traumatic osteomyelitis

Treatment

Source: http://www.tiensmed.ru/news/toespain-u7v.html3.

Pain at the fracture site when palpated;Changes in its shape.

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Once a man was diagnosed with osteomyelitis.

Classification of osteomyelitis

Sepsis – blood poisoning; secondary anemia - anemia, develops due to inhibition of hematopoiesis against the background of chronic inflammation; Amyloidosis is an autoimmune disease that primarily affects the kidneys and is difficult to treat.

In the presence of an open purulent wound or fistulous tract, a culture of the purulent discharge from them is performed in order to determine the pathogen and its sensitivity to antibiotics.

If the infection penetrates from the outside during an injury, then signs of inflammation gradually appear: the injured limb becomes swollen and thick, it is painful, and pus begins to ooze from the wound. At the same time, the general condition worsens: weakness, weakness appear, body temperature rises.

There are three forms of the disease:
Pain during hypothermia. Two main pathologies characterized by similar symptoms are obliterating endarteritis and atherosclerosis of the arteries of the lower extremities.
significant swelling;

Acute osteomyelitis

Pain in the toes

Hematogenous osteomyelitis

Wounds appeared on my leg, the joint hurt all the time, and pus was coming out of the bone. Cleaning the bones did not help, and soon the man could no longer walk, as the disease had reached its final stage. There was not the slightest hope for recovery, and the doctors suggested amputating his leg.

Causes of hematogenous osteomyelitis

The frequency of complications and the likelihood of osteomyelitis transitioning to the chronic stage directly depends on the time of contacting a doctor. This is why it is so important to consult a specialist at the first signs of the disease. You should not self-medicate: if there is a purulent focus in the bone or soft tissues, it is necessary to drain the pus (perform surgery). Until this is accomplished, even the use of modern antibiotics will be ineffective.

To visually confirm the presence of osteomyelitis, an x-ray of the affected area of the body is performed. However, it should be remembered that the X-ray picture of the disease lags behind the clinical one by 2 weeks, so in the case of acute osteomyelitis there may not be obvious changes at the onset of the disease.

In some patients, osteomyelitis becomes chronic. In this case, fistulas (channels connecting the purulent focus with the surface of the skin) and sequestra (separated and dead bone fragments) are formed. For some time the patient's condition improves. Subsequently, exacerbations periodically occur, during which the body temperature rises, pain occurs again, the fistula opens, and pus begins to be released from it.

Septic-pyemic

- inflammation of the bone marrow, which usually affects all elements of the bone (periosteum, spongy and compact substance). According to statistics, osteomyelitis after injuries and operations accounts for 6.5% of all diseases of the musculoskeletal system. Depending on the etiology of osteomyelitis, it is divided into nonspecific and specific (tuberculous, syphilitic, brucellosis, etc.); post-traumatic, hematogenous, postoperative, contact. The clinical picture depends on the type of osteomyelitis and its form (acute or chronic). The basis of treatment for acute osteomyelitis is the opening and sanitation of all ulcers, for chronic osteomyelitis - removal of cavities, fistulas and sequestration.

Endarteritis is an inflammatory lesion of arterial vessels, which most often occurs in the lower extremities. A characteristic symptom of this disease is the so-called “intermittent claudication.” When walking begins, movements are relatively easy for the patient, but then pain, numbness and heaviness rapidly increase in the legs. All these symptoms disappear after a short rest, but appear again after the next few steps. In addition, endarteritis, as well as atherosclerotic lesions of the arteries of the lower extremities, is characterized by a frequent feeling of cold in the legs. Patients also often complain of cramps in the muscles of the legs.

Unnatural crunching noise under load. With different types of arthritis, pain develops in different fingers. For example, for psoriatic and reactive arthritis, damage to the big toes is more typical.

can be caused by a number of disorders, among which are the following:

Post-traumatic osteomyelitis

One grandmother saved this man. She was a healer and knew a folk remedy for treating osteomyelitis. For the recipe you need to take a medium onion, a piece of laundry soap the size of a matchbox and a grater. Chop the onion and grate the soap.

Gunshot osteomyelitis

Osteomyelitis is a disease that requires hospital treatment. When the first symptoms appear, you should immediately consult a traumatologist.

At about 4 weeks, in all forms of acute osteomyelitis, sequestration occurs - the formation of a dead area of bone surrounded by altered bone tissue. At 2-3 months of the disease, the sequestra are finally separated, a cavity is formed at the site of bone destruction and the process becomes chronic.

Postoperative osteomyelitis

Characterized by an acute onset and severe intoxication. Body temperature rises to 39-40°, accompanied by chills, headache and repeated vomiting. Possible loss of consciousness, delirium, convulsions, hemolytic jaundice. The patient's face is pale, lips and mucous membranes are bluish, and the skin is dry. The pulse is increased, the pressure is reduced. The spleen and liver enlarge, and sometimes bronchopneumonia develops.

Contact osteomyelitis

Treatment of acute osteomyelitis

The cause of pain in the toes may be atherosclerosis of the arteries of the lower extremities. This pathology occurs when cholesterol plaques are deposited on the inner surface of the walls of blood vessels. This disease is characterized by thickening of the vascular wall, which is manifested by a feeling of squeezing pain in the muscles of the legs and feet. Pain increases when walking. In addition, a characteristic sign of atherosclerosis of the arteries of the lower extremities is the feeling of cold feet, regardless of the time of year.

pain with passive finger movements;

Osteoarthritis is a degenerative-dystrophic disease of the joint that develops as a result of the destruction of cartilage tissue on the articular surface. With this pathology, pain initially occurs periodically, only after physical activity, and quickly disappears with rest. But as the disease progresses, the intensity of the pain increases; it does not disappear after rest, and may appear at night.

Chronic osteomyelitis

gout;

Mix all this and put the resulting slurry on a cloth. Apply the prepared compress to the sore spot and secure with a bandage.

Symptoms

Surgeon Tevs D.S.

The figure shows a typical x-ray picture of osteomyelitis - a cavity in the bone, a pathological fracture.

Treatment of acute osteomyelitis is carried out in the department of purulent surgery. The injured limb needs rest, so it is fixed with a plaster splint. Antibiotics are prescribed. A prerequisite for recovery is the outflow of pus. Therefore, the surgeon makes incisions in the skin and holes in the bone, which are washed with antiseptic solutions.

Complications of chronic osteomyelitis

With the transition of acute osteomyelitis to chronic, the patient's condition improves. The pain decreases and becomes aching. Fistula tracts are formed, which may look like a complex system of canals and extend to the surface of the skin far from the site of injury. A moderate amount of purulent discharge is released from the fistulas.

Diagnosis of chronic osteomyelitis

Treatment of chronic osteomyelitis

Pain in the toes, especially in the spaces between them, can be a consequence of dermatological diseases. Most often these are massive fungal infections of the feet.

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General information

bruises on the lateral and dorsal surfaces.

Signs of osteoarthritis are the following symptoms:

Causes of osteomyelitis

dermatological diseases.

The man did this every day and was eventually able to completely recover from osteomyelitis.
This is an infection. It penetrates the bone, and inflammation begins in this place. The process even affects the bone marrow. Osteomyelitis can be acute or chronic.
A more sensitive diagnostic method is computed tomography, which allows a more detailed examination of bone tissue defects. The capabilities of computed tomography exceed magnetic resonance imaging. The latter makes it possible to differentiate soft tissue diseases from the affected bone and determine the extent of non-viable tissue. Therefore, when choosing between computed tomography and magnetic resonance imaging, preference should be given to the latter.

Symptoms of osteomyelitis

To normalize the general condition and remove toxins from the blood, intravenous administration of various solutions is prescribed using droppers. In severe cases, various methods of artificial blood purification are used: hemosorption, plasmapheresis.

During the period of remission the patient's condition is satisfactory. The pain disappears, the discharge from the fistula becomes scarce. Sometimes the fistulas close. The duration of remission for osteomyelitis ranges from several weeks to several decades, depending on the general condition and age of the patient, localization of the lesion, etc.

More often it affects the femur and humerus, lower leg bones, vertebrae, mandibular joints and upper jaw. After open fractures of the diaphysis of long bones, post-traumatic osteomyelitis occurs in 16.3% of cases.

What can you do?

In addition to pain between the toes, similar disorders also appear:

What can a doctor do?

Pain and lameness from a fracture persist for a long time. A characteristic symptom is that to reduce pain, a person usually tries to shift the weight to the heel. Often the nail bed is also damaged, which subsequently serves as a site for infection. Functional impairments with fractures of the II, III, IV and V toes may not be particularly noticeable. Therefore, at first the patient may not even suspect the presence of a fracture. Only after some time, when pain increases, does a person consult a doctor.

morning stiffness;

Gout is a disease caused by a disorder of purine metabolism. It is characterized by an increase in the amount of uric acid in the blood, and deposits of its salts (urates) in the joint tissues. Typically, a gout attack begins with the appearance of pain in the joint of the big toe. As the disease develops, the pathological process can spread to an increasing number of joints - polyarthritis occurs. But most often, gout affects the joints of the lower extremities: knees, ankles, foot joints. And the most pronounced disorders and pain are observed in the joints of the toes. Gout attacks begin mainly at night. This attack is characterized by a rapid increase in local temperature around the joint and its redness. Its swelling and pain quickly increases. An excruciating burning pain spreads from the toes up the leg. Inflammation can also affect soft tissues, forming the clinical picture of phlebitis or cellulite. The average duration of gout attacks is several days, and sometimes weeks. After the symptoms subside, the joint gradually acquires its normal shape.

Forecast

This story happened to a little boy. Even in early childhood, he was given a terrible diagnosis - osteomyelitis. The parents tried their best to cure the baby and bought the most expensive medicines. All efforts were useless. But my mother read in the newspaper that osteomyelitis can be cured with lilac. Out of despair, the parents decided to try this method. He lived up to expectations, the boy began to recover.

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Osteomyelitis - Causes, symptoms and treatment. MJ

If the disease was caused by some kind of infection in the body, then its development occurs very quickly. The process takes only two days, during which the symptoms are very difficult to notice, much less associate with osteomyelitis. First, muscle pain, joint problems, and general malaise appear. These symptoms are very common, and most often people are not even aware of the disease. Afterwards the temperature rises, sometimes reaching forty degrees. Then the bone affected by the disease begins to hurt very much.

Symptoms of osteomyelitis

It is possible to perform an ultrasound examination. It allows you to identify the accumulation of pus in soft tissues, the presence and extent of fistula tracts, changes in the periosteum, and also assess the blood supply to the limb.

In case of chronic osteomyelitis, an operation is performed during which all dead tissue and bone fragments are removed and fistulas are excised.

Local

Men suffer from osteomyelitis more often than women, children and the elderly - more often than young and middle-aged people.

itching and burning on the skin of the foot;

First aid for suspected osteomyelitis

Osteomyelitis is a purulent-necrotic process that occurs in the bone and bone marrow, affecting the surrounding soft tissue. The cause of this pathology is the penetration of microflora into the body that produces pus. Often, osteomyelitis in the toes develops as a complication of various bone pathologies, for example, with open fractures. Acute osteomyelitis begins with a sharp increase in body temperature to 39-40oC. The patient's condition is greatly deteriorating, which is due to increasing intoxication of the body. This disease also manifests itself with the following symptoms: In the first few days, severe pain appears in the foot, which can spread to the lower leg. Painful contractures develop in the affected bones and joints. Active movement of the toes is impossible, and passive movement is severely limited. Edema in the muscles and soft tissues of the foot and leg quickly increases. The skin over the affected area becomes purple in color and is very tense. Often a pronounced venous pattern appears on it. When the disease becomes chronic, the patient’s well-being may improve somewhat, the severity of pain in the foot decreases, and the pain itself becomes aching. Signs of intoxication in the body disappear, and body temperature returns to normal. Often, fistulas with scant purulent discharge form in the affected area. Several such fistulas can form a network of subcutaneous channels, which subsequently open at a great distance from the pathological focus. Subsequently, persistent immobility of the foot joints and curvature of the toe bones occur.

painful lumps on the edges of the joint space;

With gout, exacerbations are observed from two to six times a year, and the factors that provoke the onset of an attack are:

Examination in hospital for suspected osteomyelitis

The main component of the recipe is flowers or buds taken from purple lilacs and pre-dried. They are poured to the top into a liter jar. Vodka is poured on top. The medicine should infuse for ten days. After this, you need to strain it and apply compresses to the affected areas. The tincture can also be taken orally. The dosage is two drops daily.

It becomes difficult to move, and the pain intensifies. Often the whole process is accompanied by vomiting and nausea.

The most modern way to diagnose osteomyelitis is radionuclide diagnostics. The method is based on the use of radioactive pharmaceuticals, which specifically accumulate at the site of inflammation, which makes it possible to determine the presence of bone tissue destruction at an early stage. Unfortunately, this is an expensive study that requires high-tech equipment and special facilities, so it is only available in large medical centers.

The prognosis for osteomyelitis depends on the form of the disease and the severity of the condition. There are so-called fulminant forms, in which all the symptoms increase very quickly, and the patient’s condition becomes serious. If medical assistance is not provided in a timely manner, death may occur.

Chronic osteomyelitis is often complicated by fractures, formation of false joints, bone deformation, contractures, purulent arthritis, malignancy (malignant degeneration of tissue). A constantly existing source of infection affects the entire body, causing amyloidosis of the kidneys and changes in internal organs. During the period of relapse and when the body is weakened, sepsis is possible. The general condition suffers less and sometimes remains satisfactory. Signs of local inflammation of bone and soft tissue predominate.

reddening of nails and changes in their shape;

Treatment of osteomyelitis

The cause of pain in the toes may be a rotating nail. The big toe is most susceptible to this pathology. The development of this disorder is provoked by wearing uncomfortable shoes, as well as cutting nails too short. Painful sensations can be quite intense. In addition, redness of the skin around the ingrown nail, its swelling, and the addition of infections are typical.

limitation of movements in the joint;

alcohol abuse;

To prepare a compress, you need to take one kilogram of butter and the same amount of rye flour and natural honey. You will also need ten chicken egg yolks. The honey should be melted in a water bath at a water temperature of about forty degrees, and the yolks should be beaten thoroughly. Next, all the ingredients are mixed.

If a patient has a toxic form of osteomyelitis, then first of all pain appears in the heart and low blood pressure is observed. Sometimes convulsions occur and loss of consciousness is possible. A person’s face turns pale, his eyes become sunken, his lips turn blue, his skin turns yellow.

Treatment of osteomyelitis is complex, possible only in a hospital setting in a trauma or surgical department, and includes conservative and surgical measures.

Low body weight, poor nutrition.

Possible complications of osteomyelitis

Making a diagnosis for chronic osteomyelitis in most cases does not cause difficulties. To confirm, tomography or radiography is performed. To identify fistula tracts and their connection with the osteomyelitic lesion, fistulography is performed.

Adynamic (toxic)

swelling of the fingertips;

Hallux valgus is a curvature of the metatarsophalangeal joint in which the big toe deviates towards its neighbors. The main reason for the development of this disorder is flat feet and weakness of the tendon-ligamentous apparatus. Additional factors that contribute to the occurrence of hallux valgus, and therefore an increase in pain, are wearing tight shoes or shoes with excessively high heels.

Prevention of complications of osteomyelitis

Characteristic crunching sound when moving.

errors in the diet in the form of a large number of meat or fatty dishes;

The resulting dough is shaped into a large flat cake. It should be placed on the sore spot overnight. Cover the top of the compress with polyethylene and bandage it.

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Osteomyelitis - causes, symptoms and folk remedies for treating osteomyelitis. Video

What is osteomyelitis?

In case of traumatic osteomyelitis, it is necessary to consult a doctor as soon as possible, since delay can lead to the death of the patient. This form of the disease is characterized by acute symptoms. Severe pain in the injured area and high fever. Later, these symptoms are replaced by chronic ones. The cause of traumatic osteomyelitis is fistula tracts. They appear next to the wound, purulent discharge comes out through them.

Symptoms and course of osteomyelitis

Conservative treatment methods include: Diagnosis of acute hematogenous osteomyelitis in the early stages is difficult.

The operation is indicated in the presence of osteomyelitic cavities and ulcers, purulent fistulas, sequesters, false joints, frequent relapses with intoxication, severe pain and dysfunction of the limb, malignancy, disruption of other organs and systems due to chronic purulent infection.

Rarely found. Characterized by lightning-fast onset. The symptoms of acute sepsis predominate: a sharp increase in temperature, severe toxicosis, convulsions, loss of consciousness, a pronounced decrease in blood pressure, acute cardiovascular failure. Signs of bone inflammation are weak and appear late, which makes diagnosis and treatment difficult. In the initial stages, exogenous and endogenous osteomyelitis differ not only in origin, but also in manifestations. Then the differences are smoothed out and both forms of the disease proceed in the same way.

Causes of osteomyelitis

disturbances in skin coloration.

In such cases, the occurrence of pain in the toes is associated with disorders of the musculoskeletal system in the form of clubfoot of varying severity. Due to improper positioning of the foot when walking, the load on it is unevenly distributed. The big toe is gradually pushed outward and upward, displacing the rest along with it. Arthrosis of the toes affects mainly women. The occurrence of the disease is provoked by wearing dress shoes with a pointed toe for many years. As a result, the thumb is deformed and curved towards the second finger. In addition, its bone begins to bulge, which rubs against the surface of the shoe, and over time also undergoes deformation. As a result, all joints of the big toe become bent and increase in size. This causes pain and limited mobility. If arthrosis progresses, then the finger can change its original shape so much that it cannot be returned to its original position, even with significant physical effort. Another complication of arthrosis of the big toe is that after it the second and third toes become deformed. The result is a combined foot deformity. In addition, due to constant friction and trauma to the joint of the 1st finger, bursitis develops in it. Abuse of coffee, cocoa or strong tea;

How serious is osteomyelitis?

The procedure must be repeated daily. Gradually, pus will begin to come out, and then the disease will pass and the wounds will heal. The person does not feel a deterioration in his condition. A severe form of the disease can lead to blood poisoning. Antibacterial therapy with broad-spectrum antibiotics - usually 2-3 drugs are prescribed (ceftriaxone, lincomycin, gentamicin) for a long time (3-4 weeks), replacing them with drugs from other groups ( for example, ciprofloxacin, abactal, etc.); detoxification therapy (intravenous administration of saline solutions and plasmapheresis, procedures for ultraviolet and laser irradiation of blood - purification of blood plasma from toxins); immunotropic therapy - the use of pharmaceuticals that increase the activity of the immune system (polyoxidonium); prescribing probiotics - drugs that normalize intestinal microflora. Due to massive antibacterial therapy, dysbiosis develops. To correct it, Linex and Bifiform are prescribed; prescription of drugs that improve blood microcirculation (pentoxifylline, trental); local treatment of the wound - dressings with antiseptic ointments (levomekol, levosin, 5% dioxidine ointment) and proteolytic enzymes (trypsin, chymotrypsin), which promote cleansing and healing of the wound.

We can distinguish general and local symptoms of the disease. The general picture of the disease, caused by the presence of bacteria in the blood (bacteremia), is as follows: after a short period of malaise, chills appear, the temperature rises from 37.5°C to 40°C, and the pulse quickens (above 90 beats per minute). At this stage, osteomyelitis can be mistaken for a common acute respiratory infection (for example, influenza).

VIDEO

Traditional treatment of osteomyelitis

Necrectomy (sequestrectomy) is performed - removal of sequesters, granulations, osteomyelitic cavities along with the internal walls and excision of fistulas, followed by lavage drainage. After sanitation of the cavities, bone grafting is performed. Occurs with open bone fractures. The development of the disease is facilitated by contamination of the wound at the time of injury. The risk of developing osteomyelitis increases with comminuted fractures, extensive soft tissue injuries, severe concomitant injuries, vascular insufficiency, and decreased immunity.

The following forms of exogenous osteomyelitis are distinguished: Establishing the correct diagnosis and prescribing therapy is best left to a specialist. If you experience pain in your toes, you should consult a traumatologist, rheumatologist or dermatologist. Of the measures that you can take yourself, the best ones are:

The development of hammertoes is associated with flattening of the foot and increased pressure on it. Most often this occurs with flat feet. As the tendons in the arch of the foot try to stabilize the foot, the muscles responsible for the mobility of the toes are subject to additional stress. The fingers are pulled back and tucked, which leads to a significant protrusion of their joints. This leads to the development of hammertooth deformation. In addition, painful calluses quickly form on joints that protrude. Deformed hammertoes rest on the shoe in various places and are subject to friction. Irritation occurs in areas where crooked toes touch the surface of the shoe. Continued irritation and friction may even lead to skin ulcerations in the affected area. As such deformities intensify, it becomes more painful and difficult for the patient to move.

Treatment of osteomyelitis with lilac

Inflammation of the joint capsule of the big toe with the accumulation of fluid (exudate) in its cavity is called bursitis. This pathology is characterized by swelling, pain, redness and heat in the area of the thumb. The main manifestation of bursitis is the presence of a mobile, round swelling in the area of the affected joint, which has a soft consistency. This swelling is quite painful to the touch and is easily identified visually. In addition, the local temperature in the area of inflammation increases, and the skin acquires a purple tint. With a long course, bursitis can become chronic. In such cases, inflammation is accompanied by the deposition of calcium salts, which causes constant pain. If the cause of bursitis was an injury to the big toe, then pathological microflora may also join the inflammatory process. Purulent bursitis occurs, and all symptoms become more pronounced:

intensive bath procedures.

Treatment of osteomyelitis with honey, rye flour, butter and yolk

This treatment method is extremely easy to use. You just need to drink fish oil morning and evening - one tablespoon - and one chicken egg.

Acute osteomyelitis can be caused by various rickettsiae, bacteria and some types of fungi. But the most common causative agent of the disease is staphylococci. Surgical treatment of osteomyelitis consists of sanitation of the purulent focus (opening and draining of purulent cavities), removal of sequesters - areas of non-viable bone tissue and performing reconstructive operations. The latter is necessary due to the formation of defects in the skin and bone tissue. Restorative operations include closing defects with local tissues, filling bones with various preparations and performing osteosynthesis (for example, with an Ilizarov apparatus).

Treatment of osteomyelitis with fish oil

On the 2nd - 3rd day of illness, local signs appear in the form of local pain over the affected area, limited mobility and swelling of the soft tissues of the limb segment, and redness of the skin. The bones of the lower extremities (femur and tibia) are most often affected. Of the bones of the upper limb, the humerus is most often affected, followed by the radius and ulna. Less commonly, the bones of the hand and foot are involved in the process, as well as the ribs, spine, collarbone, pelvis, and shoulder blades.

Osteomyelitis of the jaws, vertebrae, humerus and femur occurs most often. Infection of the red bone marrow can occur in different ways, and osteomyelitis can occur in different forms and have varying degrees of severity.

Post-traumatic osteomyelitis affects all parts of the bone. In linear fractures, the area of inflammation is usually limited to the fracture site; in comminuted fractures, the purulent process tends to spread. Accompanied by hectic fever, severe intoxication (weakness, fatigue, headache, etc.), anemia, leukocytosis, increased ESR. The tissues in the area of the fracture are swollen, hyperemic, and sharply painful. A large amount of pus is released from the wound.

Treatment of osteomyelitis with baths

post-traumatic (after open fractures);

wearing comfortable, wide shoes with low heels;The growths of dead cells that form dense hardenings on the skin are called calluses. In most cases, such growths occur on the balls of the toes, on the heels or on the lateral surfaces of the big toe. Often such hardening has a long base in the form of a root penetrating deeply into the tissue. Calluses are usually painless at rest, but have a pronounced pain intensity with exercise, walking and pressure on the affected area.

Tendinitis is a whole group of inflammatory tendon lesions. In the event that the process affects not only the tendon, but also the surrounding membranes, they speak of the occurrence of tenosynovitis. The ligamentous apparatus of the big toe is susceptible to this disease due to its high traumatic nature. In addition, inflammation of the foot ligaments can cause pain not only in the big toe, but also in the rest of the toes. The main symptoms of tendinitis are:

Another characteristic

Sometimes it can be difficult to force yourself to drink a full spoonful of fish oil. Then you can gradually increase the dose, starting with just a few drops. They must be washed down with an egg. The amount of fish oil consumed should soon be equal to one tablespoon, as required by the recipe.

Hematogenous osteomyelitis is typical for young children and infants. They say about him that he is born of blood. The source of infection can be anything. For example, a bad tooth. The microbes formed there pass into the medullary canal of the long tubular bone.

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Osteomyelitis of the toe in diabetes mellitus treatment » Diabetes

  In exogenous acute osteomyelitis, local signs of the disease come to the fore: the presence of a purulent wound, previous trauma and deformation of the contours of the limb, redness and increased temperature of the skin, swelling and tenderness of soft tissues to the touch, pain when moving in the affected area of the body. General symptoms are less pronounced and usually fade into the background.

The disease most often occurs in children and the elderly. In young people and older people - less often.
More often occurs with extensive lesions of bones and soft tissues. The development of osteomyelitis is promoted by psychological stress, decreased body resistance and insufficient wound treatment.

Acute pain in the toes due to gout

gunshot (after gunshot fractures); strict adherence to foot hygiene;

Morton's neuroma, or plantar fasciitis, is an inflammation of the foot's own ligaments. The cause of pain in this disease is too much pressure on the nerves that run along the arch of the foot. Women are susceptible to this pathology much more often than men, due to chronic microtrauma of the feet when wearing high-heeled shoes. Due to pinched nerves, traumatic neuritis develops. The inflammation is chronic, resulting in constant pain under the toes. Pain from this disease is usually localized at the base of the second, third and fourth toes. It tends to increase with prolonged walking and carrying heavy objects. In addition, it often radiates into the fingers themselves, as well as upward into the lower leg.
pain in toes when walking;
symptom
A little later, you can add natural ginseng infusion to your diet. It should be taken daily in drops.

It can be either in the child’s hand or leg. Much less often, osteomyelitis gets onto the bone from infected soft tissues located close to it. Osteosynthesis using the Ilizarov apparatus With such symptoms, an abscess (a limited accumulation of pus in soft tissues), phlegmon (a widespread purulent infection in soft tissues), erysipelas, post-traumatic hematoma (local accumulation of blood) can be mistaken for osteomyelitis. These conditions also require emergency medical attention.

Pain in the joints of the toes due to arthritis

The main reason for the development of osteomyelitis is infection in the red bone marrow. The most common causative agent is staphylococcus bacteria. Infection can occur in different ways: General symptoms are similar to post-traumatic osteomyelitis. Local symptoms in acute gunshot osteomyelitis are often mild. The swelling of the limb is moderate, there is no profuse purulent discharge. The development of osteomyelitis is indicated by a change in the wound surface, which becomes dull and covered with a gray coating. Subsequently, inflammation spreads to all layers of the bone.postoperative (after wires or bone surgeries);preventing injuries and damage to the toes;One of the common symptoms of diabetes is changes in sensitivity and pain in the toes that appear when walking. Also, with diabetes, a burning sensation in the feet is often observed, mainly at night. The cause of these conditions is poor circulation in the lower extremities and damage to nerve endings. relative painlessness during passive movements;gout are tophi, which look like foci of pathological compactions located in the subcutaneous tissue. They are usually localized above the affected joints, on the extensor surfaces of the legs and thighs, on the ears, on the Achilles tendons or on the forehead. Various baths can be used.

Pain in the joints of the toes with arthrosis

An open fracture can also cause osteomyelitis. In this case, it will be very easy for infection to get into the bone. Through a laceration. There are no restrictions on diet after surgery. A nutritious diet rich in vitamins and proteins is necessary. The amount of physical activity should be discussed with your doctor individually. It is advisable to stop drinking alcohol and smoking - they slow down the wound healing process. If you have diabetes, you should monitor your blood sugar level; if it increases, a relapse of the disease is possible. In the postoperative period and after discharge from the hospital, physical therapy and physiotherapeutic treatment (electrophoresis, phonophoresis, magnetic therapy) are necessary.

In the chronic course of the disease, the above symptoms are supplemented by previously suffered osteomyelitis and the presence of fistula tracts (round purulent wounds of small diameter on the skin, from which purulent discharge comes).
Direct entry of bacteria into the bone during injury.
Despite the presence of a focus of infection, with gunshot osteomyelitis, bone fusion usually occurs (with the exception of significant bone fragmentation, large displacement of fragments). In this case, purulent foci end up in the callus.
contact (when inflammation passes from surrounding tissues).

Periodic preventive measures in the form of foot baths or foot massage.

Pain in the big toe due to bursitis

Pain in the toes can be a manifestation of damage to the arterial vessels of the lower extremities. Common symptoms for such diseases are:

Pain in big toes due to tendonitis

Pain when palpating along the inflamed tendons;

Arthritis is a chronic or acute inflammation of the joint and surrounding tissues. This pathology is one of the manifestations of any systemic connective tissue disease: Isolated lesions of the toes in arthritis are quite rare. Most often, in such patients, the inflammatory process spreads to other joints. In addition, arthritis is very characterized by symmetrical pain, that is, damage to the same joints on both legs. Arthritic pain in an inflamed joint usually has a very pronounced intensity. It appears not only during movements, but also at rest. Severe swelling and swelling also occurs in arthritic joints. The skin over the inflamed areas acquires a red, purple tint, and the local temperature increases.
For the first of them you will need ash generated from the combustion of aspen firewood. Approximately three hundred grams of ash should be placed in a bucket of water, boil it and let it brew. The resulting mixture is used to make baths for fifteen minutes. Their temperature should be approximately thirty-eight degrees. This should be done before bedtime so that you can go to bed immediately after the procedure.
Patients are often interested in what is considered osteomyelitis. Maybe it's just a bone inflammation? Or a serious illness? And can it affect the body as a whole? Such questions are born due to the existing stereotype. Most people are sure that osteomyelitis is just inflammation. It only affects a small area of the bone. That’s why they relax when they hear the doctor’s diagnosis. Patients simply do not understand the seriousness of the disease, believing that it does not in any way affect the processes occurring in the body.
Complications of osteomyelitis can be local and general.
Post-traumatic osteomyelitis develops some time (1 - 2 weeks) after injury, so it is important to properly treat the wound and consult a doctor in a timely manner. If you have received an extensive injury with a violation of the integrity of the skin, then the resulting wound should be washed with a soap solution and a 0.05% solution of chlorhexidine digluconate in order to mechanically remove microorganisms. The skin around the wound should be treated with a solution of brilliant green, and a sterile napkin (sold at the pharmacy) should be placed on the wound. A napkin can be soaked in a 3% hydrogen peroxide solution to stop bleeding. The limb should be immobilized. You can apply ice. Next, you need to go to the emergency room, where you will be examined by a traumatologist.

Toe injuries

Infection during surgery. It is a type of post-traumatic osteomyelitis. Occurs after osteosynthesis operations of closed fractures, orthopedic operations, insertion of wires when applying compression-distraction devices or applying skeletal traction (wire osteomyelitis). As a rule, the development of osteomyelitis is caused by non-compliance with asepsis rules or a highly traumatic operation.

As a rule, osteomyelitis is acute at first. In favorable cases it ends with recovery, in unfavorable cases it becomes chronic. In atypical forms of osteomyelitis (Brodie's abscess, Ollier's albuminous osteomyelitis, Garre's sclerosing osteomyelitis) and some infectious diseases (syphilis, tuberculosis, etc.) there is no acute phase of inflammation, the process is primarily chronic.
1.
increase in temperature and redness of the skin over the area of inflammation;
In addition to pain, symptoms of arthritis also include:

Take baths every other day. The course of treatment includes ten procedures. You cannot prepare the solution in advance; only fresh solution will be beneficial.

A patient who has such an opinion about the disease will not take treatment seriously. In this case, frivolity sometimes results in complications and even death.

Ingrown nail

Local complications include:

Pain in the big toe joint due to valgus deformity

Treatment of osteomyelitis that occurs after fractures, as well as metal osteosynthesis operations, is carried out by traumatologists. In other cases (hematogenous osteomyelitis, contact osteomyelitis), you should seek help from a surgeon at the on-duty surgical hospital or a surgeon at the clinic.

Incorrect foot position

Infection enters the bone through the bloodstream from chronic foci of inflammation.

Hammertoe deformity

Arises from purulent processes in the soft tissue surrounding the bone. Especially often, the infection spreads from soft tissue to the bone with panaritium, abscesses and phlegmon of the hand, and extensive wounds of the scalp. Accompanied by increased swelling, increased pain in the area of injury and the formation of fistulas.

Calluses

Pain under the toes due to Morton's neuroma

Pashkov M.K.

Diabetes mellitus

Whiteness of toes.

Vascular diseases

determination of crepitus (crunching) when moving. 1. After such a bath, you can apply your own ointment to the wound. You need to take the yolk of a fresh egg (not from the store, but just laid the other day by a chicken), a teaspoon of medical alcohol, the same amount of melted butter, a third of a teaspoon of baking soda and half a church candle. The candle needs to be melted without letting the wax boil. All the listed ingredients are mixed with it. Before applying the ointment, the wound should be treated with a sterile cloth. The applied ointment must be covered with a sterile napkin and the whole thing bandaged. Like aspen baths, the procedure is carried out every other day. Therefore, it is very important that the doctor can clearly explain to the patient how dangerous osteomyelitis is and what will happen if it is not treated properly. Abscess and phlegmon of soft tissues - accumulation of pus and purulent impregnation soft tissue surrounding the affected bone; purulent arthritis - purulent inflammation of the joint located next to the osteomyelitic lesion; spontaneous fractures - occur at the slightest load due to loss of bone tissue strength; contractures – impaired mobility due to the formation of scars in the muscles surrounding the purulent focus; ankylosis - loss of mobility in joints affected by purulent arthritis; Often in the case of hematogenous osteomyelitis, patients end up in non-core departments, in particular, in infectious or therapeutic departments. However, after symptoms of bone damage appear, they are transferred to the surgical department. Manifestations of the disease depend on how the infection occurred. If the infection has penetrated the red bone marrow through the bloodstream, then often at the onset of the disease the general condition deteriorates greatly, the body temperature rises, the patient becomes lethargic and turns pale. Around the 2nd day, severe boring pain appears in the area of the affected bone. Swelling appears in this place, the skin acquires a purple or bluish tint, and the palpation is very painful.

Endarteritis

Only in hospital in the traumatology department. The limb is immobilized. Massive antibiotic therapy is carried out taking into account the sensitivity of microorganisms. To reduce intoxication, replenish blood volume and improve local blood circulation, plasma, hemodez, and 10% albumin solution are transfused. For sepsis, extracorporeal hemocorrection methods are used: hemosorption and lymphosorption.

Atherosclerosis of the arteries

Pain between the toes in dermatological pathologies

Project Content Coordinator. 2.

Among toe injuries, the most common are fractures of the phalangeal bones. This is due to the fact that the phalanges of the fingers are poorly protected from external influences, and these bones themselves are small in diameter and do not have significant strength. Most often, the terminal phalanges of the 1st and 2nd toes are susceptible to fractures, since they protrude significantly forward compared to the rest.
Limitation of movements in the joint.
If it happens in the summer, then an excellent way to treat osteomyelitis is sunbathing. You should stay in the sun until ten o'clock in the morning. The length of stay should be gradually increased, starting from ten minutes.
The patient's attention should be drawn to the fact that with this disease the kidneys and liver, as well as the immune system, work much worse. Another characteristic is exhaustion of the body. There are frequent cases of patient death not even from osteomyelitis, but from diseases caused by it. Usually they affect not entirely healthy human organs.

Treatment

General complications include:

To diagnose osteomyelitis, you will need to undergo the following examination. Take a general blood and urine test, a blood test for glucose levels (to detect diabetes). If possible, you should donate blood for C-reactive protein, which is a sensitive indicator of the presence of inflammation.
An abscess appears in the bone. It can spread to nearby muscles and joints. In other cases, pus breaks out after some time and a fistula forms.
A prerequisite for successful treatment of acute osteomyelitis is drainage of the purulent focus. In the early stages, burr holes are made in the bone, followed by washing with solutions of antibiotics and proteolytic enzymes.
From a remote source of inflammation (soft tissue abscess, phlegmon, infected wound, etc.), microbes are carried through the blood throughout the body. In long tubular bones, especially in their middle part, a wide network of vessels is well developed, in which the speed of blood flow slows down. Infectious agents settle in the cancellous bone. Under unfavorable conditions (hypothermia, decreased immunity), microbes begin to multiply rapidly, and hematogenous osteomyelitis develops.

The information posted on our website is for reference or popular and is provided to a wide range of readers for discussion. The prescription of medications should be carried out only by a qualified specialist, based on the medical history and diagnostic results.In case of a fracture of the phalanx of the toe in the first hours after the injury, the following are determined:

ATTENTION!

Another remedy for osteomyelitis is eggshells. It must be crushed and taken daily on an empty stomach. It is best to drink the shells with lemon juice, but you can also use plain water.

Bone felon is a deep type of felon or osteomyelitis. The disease occurs in 5-6% of cases of all felons. In the vast majority of cases, bone panaritium begins when the infectious-inflammatory process moves from the surrounding soft tissues of the finger.

How and why it develops

The inflammatory process in the bone can be of primary, secondary and hematogenous origin. In this case, the secondary origin of the bone panaritium is the most common - in 95% of cases, the infection spreads to the bone from surrounding tissues with a prolonged course of subcutaneous panaritium . This usually occurs when the subcutaneous panaritium is insufficiently opened or when the wound is poorly drained after surgery.

There are bone felons of the distal (end), middle and proximal (closest to the palm) phalanges of the finger. Bone felon is most often localized on the terminal nail phalanx, since this phalanx is most often injured and also has a closed cellular space around it. In addition, the vessels feeding the bone are terminal in nature and are easily thrombosed even with inflammation of the soft tissues.

The inflammatory process occurs in three stages. In the initial stage, infiltration occurs - an influx of blood cells to the affected bone, which try to cope with the infection. In the second stage, focal dilatations of blood vessels and their thrombosis are observed . The third stage is characterized by diffuse purulent inflammation of bone tissue, rarefaction of bone tissue (osteoporosis) and bone destruction with the formation of sequesters (separated areas of bone) or areas of bone melting.

Early diagnosis of bone panaritium is difficult, so timely and adequate treatment is often delayed. This happens because destructive changes in the bone (and therefore changes on x-rays) begin to be determined only two weeks or later after the onset of osteomyelitis . Therefore, practical surgeons believe that if the subcutaneous panaritium is not eliminated within 1.5 weeks after surgery, then the bone is most likely involved in the purulent process.

Signs of bone panaritium

All symptoms of bone felon in the initial stage are similar to the symptoms of subcutaneous felon. This is a sudden onset with fever, chills, weakness, pain in the finger, which is constant or pulsating.

After some time, all the symptoms of the disease worsen. When the distal phalanx is affected, the finger becomes flask-shaped with tense, shiny, smooth skin. The pain in the finger becomes constant, chills and headaches appear, and the temperature rises to high levels. Tendons and joints may be involved in purulent processes.

Complications

Complications of bone panaritium often occur as a result of untimely or improper treatment. The inflammatory purulent process can spread to the interphalangeal and metacarpophalangeal joints - articular panaritium develops. In the first stage of the process, inflammation spreads only to the soft tissues of the joint. Redness and swelling of the skin over the joint appears, the interphalangeal folds become smooth, and the finger acquires a spindle-shaped shape. Jerky pressure along the longitudinal axis of the finger increases constant pain.

In the second stage, articular cartilage and lateral ligaments are destroyed, destruction of the bones that form the joint and pathological mobility of the finger occurs, up to subluxation in the joint. Spontaneous opening of such a panaritium may occur with the formation of a fistula with purulent discharge.

By the way, when they looked at the first X-ray, they were horrified at our doctors, because on the first X-ray it was already clear that all the phalanges on the finger were torn.

The child has been in the hospital for 3 weeks and still needs to stay for at least 2 weeks. The child is 11 years old and studying in the 5th grade.

There is no particular outcome. What to do.

Can this disease cause disability?

(he just said today that he will need to go to the hospital every 2 months).

How to treat bone osteomyelitis? Causes, symptoms, diagnosis and folk remedies.

Inside the bones is bone marrow. When it becomes inflamed, osteomyelitis develops. The disease spreads to the compact and spongy bone substance, and then to the periosteum.

What it is

Osteomyelitis is an infectious disease that affects the bone marrow and bone. The causative agents of the disease penetrate the bone tissue through the bloodstream or from neighboring organs. The infectious process can primarily occur in the bone when it is damaged due to a gunshot wound or fracture.

In pediatric patients, the disease mainly affects the long bones of the upper or lower extremities. In adult patients, the incidence of osteomyelitic process in the spine increases. In people with diabetes, the disease can affect the bones of the feet.

This pathology was considered incurable before the invention of antibiotics. Modern medicine copes with it quite effectively, using surgical removal of the necrotic part of the bone and a long course of potent antimicrobial agents.

There are several theories about the development of the disease. According to one of them, proposed by A. Bobrov and E. Lexer, an accumulation of microbes (embolus) forms in a distant focus of inflammation. Through the blood vessels it enters the narrow terminal arteries of the bones, where the speed of blood flow slows down. Microorganisms settled in this place cause inflammation.

It is also assumed that the basis of the disease is allergization of the body in response to a bacterial infection.

If microbial agents are weakened and the body’s immune response is strong enough, osteomyelitis can become primary chronic without suppuration and bone destruction.

The development of inflammation in the bone substance causes the formation of sequestration - a specific sign of osteomyelitis. This is a dead part that is spontaneously rejected. Vascular thrombosis occurs around the sequestration, and blood circulation and bone nutrition are disrupted.

Immune cells accumulate around the sequestration, forming a granulation shaft. It manifests itself as thickening of the periosteum (periostitis). The granulation shaft well distinguishes dead tissue from healthy tissue. Periostitis, along with sequestration, is a specific sign of osteomyelitis.

Classification

Clinical classification of osteomyelitis is carried out according to many criteria. The more precise the diagnosis, the clearer the treatment tactics become.

Types of disease depending on the pathogen:

caused by nonspecific microflora (gram-positive or gram-negative): staphylococcus, pneumococcus, streptococcus, proteus, Escherichia coli and Pseudomonas aeruginosa, less commonly anaerobes:
caused by one type of microbe (monoculture);
associated with the association of 2 or 3 different types of microorganisms.
specific for infectious pathology:
syphilitic;
leprous;
tuberculosis;
brucellosis;
other.
no pathogen was detected.

Bactericidal damage to bone layers.

There are clinical forms of the disease:

hematogenous:
after an infection of another organ;
post-vaccination;
other.
post-traumatic:
after fractures;
after operation;
when using spoke devices.
firearms;
radiation;
atypical (primary chronic):
Brody's abscess;
Ollier and Garré osteomyelitis;
tumor-like.

generalized:
septicotoxic;
septicopyemic;
isolated toxic.
focal:
fistulous;
fistulaless.

acute (in particular, lightning);
subacute;
primary chronic;
chronic.

The following stages of the osteomyelitic process are distinguished:

intramedullary (only the bone marrow is affected);
extramedullary.

Based on localization, osteomyelitis of tubular and flat bones is distinguished. In long tubular bones, different parts can be affected: epiphysis, diaphysis, metaphysis. Among the flat bones affected are the skull, vertebrae, shoulder blades, sit bones and ribs.

Local complications of osteomyelitis:

sequestration;
fracture;
bone, paraosseous or soft tissue phlegmon;
pathological dislocation;
formation of a false joint;
ankylosis;
joint contractures;
violation of bone shape and development;
bleeding;
fistulas;
vascular complications;
neurological complications;
muscle and skin disorders;
gangrene;
malignancy.

Variants of the disease with common complications:

amyloid damage to the kidneys and heart;
severe pneumonia with lung collapse;
inflammation of the pericardium;
sepsis;
other.

The most common variants of the disease are acute hematogenous (in childhood) and chronic post-traumatic (in adult patients).

The disease most often affects certain bones of the human body.

Osteomyelitis of the thigh

Symptoms of femoral osteomyelitis.

It is observed in people of any age, most often of hematogenous origin, but often develops after surgery on the bones. Accompanied by swelling of the thigh, fever and impaired mobility of adjacent joints. A large fistula forms on the skin, through which pus is discharged.

Osteomyelitis of the leg bones

Signs of osteomyelitis of the lower leg bone.

It is observed more often in adolescents and adults, and often complicates the course of tibia fractures. Accompanied by redness and swelling of the lower leg, severe pain, and the formation of fistula tracts with purulent discharge. The tibia is affected first, but then the fibula always becomes inflamed. The patient cannot step on his foot.

Osteomyelitis of the calcaneus

Signs of osteomyelitis of the calcaneus.

Unlike the forms described above, it usually has a long course and often complicates infectious diseases of the foot, for example, diabetes. The main signs are pain and swelling in the heel, redness of the skin, and the formation of an ulcer with the release of purulent contents. The patient may have difficulty walking while resting on the front of the foot.

Osteomyelitis of the shoulder

It often occurs in childhood, has an acute course, accompanied by fever, swelling, and pain in the arm. As the disease progresses, pathological fractures are possible.

Metatarsal osteomyelitis

Signs of osteomyelitis of the metatarsal bone.

It develops when the surgical treatment of a wound resulting from a foot injury is insufficiently thorough. It can also complicate the course of diabetes. Accompanied by pain and swelling of the foot, difficulty walking.

Vertebral osteomyelitis

Develops mainly in adults against the background of immunodeficiency or septic condition. Accompanied by back pain, headache, palpitations, weakness, fever.

Causes

The vast majority of cases of the disease are caused by staphylococci.

These microorganisms are widely distributed in the external environment. They are found on the surface of the skin and in the nasal cavity of many healthy people.

Damage to staphylococcal infection.

Microbial agents can penetrate bone matter in different ways:

Through blood vessels. Bacteria that cause inflammation in other organs, for example, pneumonia or pyelonephritis, can spread through the vessels into the bone tissue. In children, the infection often penetrates into the growth areas - the cartilaginous plates at the ends of the tubular bones - the humerus or femur.
Infected wounds, endoprostheses. Microorganisms from puncture, cut and other wounds enter the muscle tissue, and from there spread to the bone substance.
Fractures or operations when infectious agents enter directly into the bone substance.

The bones of a healthy person are resistant to the development of osteomyelitis. Factors that increase the likelihood of pathology:

recent injury or surgery to bones or joints, including hip or knee replacement;
implantation of a metal bracket or wires during osteosynthesis;
animal bite;
diabetes with high blood sugar;
peripheral arterial diseases, often associated with atherosclerosis and smoking, for example, atherosclerosis or obliterating endarteritis;
the presence of an intravenous or urinary catheter, frequent intravenous injections;
hemodialysis;
chemotherapy for cancer;
long-term use of glucocorticoid hormones;
injection drug addiction.

Diagnostics

The doctor examines the area around the affected bone to look for swelling, redness, and tenderness of the tissue. A blunt probe is used to examine fistulas.

Blood tests reveal signs of inflammation - an increase in ESR and the number of white blood cells. Blood and fistula discharge are subjected to microbiological examination to recognize the type of microorganism and determine antibacterial agents that effectively destroy it.

The main diagnostic procedures for osteomyelitis are imaging tests.

The area around the affected bone is swollen, red and tender.

X-ray of bones is used to identify necrotic areas of bone - sequestra. Fistulography - the introduction of a radiopaque substance into the fistula tract - is used to study the internal structure of the fistula. In the early stages of the disease, X-ray examination provides little information.

A CT scan is a series of x-rays taken from different positions. When analyzed, a detailed three-dimensional picture of the affected bone is formed.

Magnetic resonance imaging is a safe research method that allows you to recreate in detail the image of not only the bone, but also the soft tissue surrounding it.

A bone biopsy is performed to confirm the diagnosis. It can be performed in the operating room under general anesthesia. In this case, the surgeon cuts the tissue and takes a piece of the inflamed material. A microbiological examination is then carried out to identify the causative agent.

In some cases, a biopsy is taken under local anesthesia using a long, strong needle passed to the site of inflammation under X-ray guidance.

Symptoms of bone osteomyelitis

fever and chills;
bone pain;
swelling of the affected area;
dysfunction of the affected limb - inability to raise an arm or step on the affected leg;
the formation of fistulas - holes in the skin through which pus is released;
poor health, in children - irritability or drowsiness.

Sometimes the disease occurs with almost no external manifestations.

You should seek medical help if you have a combination of fever and pain in one or more bones.

The doctor must conduct a differential diagnosis with the following diseases:

Chronic osteomyelitis of bone

This form most often serves as the outcome of an acute process. A sequestral cavity is formed in the bone substance. It contains loose pieces of dead bone tissue and liquid purulent discharge. The contents of the sequestration box are released through the fistulas onto the surface of the skin.

Fistulas on the surface of the skin.

The development of the disease is wave-like: the closure of the fistula is replaced by a new phase of inflammation and pus discharge. When the exacerbation subsides, the patient's condition improves. Skin temperature normalizes, pain disappears. Blood counts are approaching normal. At this time, new sequesters are gradually formed in the bone substance, which begin to be rejected and cause an exacerbation. The duration of remission can be several years.

Signs of relapse resemble acute osteomyelitis. Inflammation and pain occur in the affected area, a fistula opens, and soft tissue phlegmon may develop. The duration of relapse is determined by many conditions, primarily the effectiveness of treatment.

Primary chronic forms occur without signs of an acute stage. Brodie's abscess is a single round cavity in the bone substance, surrounded by a capsule and located in the bones of the leg. The abscess contains pus. There are no pronounced symptoms of the inflammatory process, the disease is sluggish. During exacerbation, pain occurs in the leg, especially at night. Fistulas do not form.

Sclerosing osteomyelitis is accompanied by an increase in bone density and periosteal layers. The bone thickens and takes on a spindle shape. The medullary canal narrows. This form is difficult to treat.

Acute osteomyelitis

The most common variant of this process is hematogenous. It is observed mainly in boys. Phlegmonous inflammation of the bone marrow canal develops.

The toxic variant occurs at lightning speed and can lead to the death of the patient within a few days. The septicopyemic variant is characterized by the presence of ulcers not only in the bone substance, but also in the internal organs.

Most patients have a local form of the disease. The disease begins suddenly. There is a feeling of fullness and intense pain in the limb, often near the knee, shoulder or elbow joints. It intensifies with movement. Body temperature rises.

There is pallor of the skin, rapid breathing and pulse, lethargy and drowsiness. The limb is in a bent position, movements in it are limited. Swelling and redness of the skin occurs above the area of inflammation. There is severe pain when tapping in the affected area or in the direction along the bone axis.

X-ray changes appear only 2 weeks after the onset of the disease.

Treatment of bone osteomyelitis

In case of an acute process, urgent hospitalization is required. Treatment is carried out using surgery and medications.

The operation includes osteoperforation - creating a hole in the bone, cleaning and draining the cavity. In severe cases, purulent leaks in the muscles are opened and bone trephination is performed. After cleansing the bone of pus, intraosseous lavage begins - the introduction into the cavity through plastic catheters of antimicrobial substances - antibiotics, chlorhexidine, rivanol, as well as enzymes.

Opening purulent leaks in the muscles.

Complex conservative treatment includes:

antibiotics in high doses;
detoxification (injection into a vein of solutions of plasma, albumin, hemodez, rheopolyglucin), forced diuresis;
correction of acid-base imbalances using intravenous infusion of sodium bicarbonate;
stimulation of tissue repair (methyluracil);
immunomodulatory agents and vitamins.

If the disease is caused by staphylococcus, specific immunotherapy methods can be used to treat it - staphylococcal toxoid, staphylococcal vaccine, gamma globulin or hyperimmune plasma with an increased content of antimicrobial antibodies.

Immobilization of the limb using a splint is mandatory. After acute inflammation subsides, physiotherapy procedures are prescribed - UHF, magnetic field and others. Hyperbaric oxygen therapy is one of the effective procedures for osteomyelitis. It involves inhaling an air-oxygen mixture in a special chamber under pressure. This helps not only to improve the blood supply to all tissues, but also to speed up the healing process of the purulent lesion.

The prognosis of the disease is usually favorable, and it ends in recovery. However, in some cases the disease becomes chronic.

The basis of treatment for the chronic variant is sequesternecrectomy. During this operation, bone sequesters are removed, the bone cavity is cleaned, and the fistulas are excised. The resulting cavity is drained. You can close them with special plastic materials.

For pathological fractures, long-term osteomyelitic process, and limb shortening, the method of compression-distraction osteosynthesis using the Ilizarov apparatus is used. Surgeons first perform a sequesterectomy and process the edges of the bone, removing all foci of infection. Then several wires are passed through the bone above and below the pathological focus. The spokes are secured with metal rings surrounding the leg or arm. Metal rods are placed between adjacent rings, parallel to the axis of the limb.

Method of compression-distraction osteosynthesis using the Ilizarov apparatus.

Using knitting needles and rods, the bone fragments are pressed against each other. At their junction, a fusion gradually forms - a callus. Its cells are dividing quite actively. After fusion of the fragments, surgeons begin to gradually move the rings away from each other, increasing the length of the rods. Stretching of the callus leads to the growth of new bone and restoration of limb length. The treatment process is quite long, but this method has many advantages compared to other types of surgery:

low morbidity;
lack of plaster immobilization;
the patient's ability to move;
the ability for the patient to independently perform distraction (stretching) after a little training;
restoration of healthy bone tissue, completely replacing the osteomyelitic defect.

In extreme cases, amputation of the limb is performed. It is indicated for the development of extensive phlegmon, especially caused by anaerobes, or gangrene of the limb.

After surgery, conservative treatment is prescribed. It includes the same drugs as for the acute form.

With proper treatment, the prognosis is favorable. However, relapses of the disease cannot be ruled out. Persisting osteomyelitis can lead to renal amyloidosis and other complications.

Antibiotics for osteomyelitis

The problem of adequate antibacterial therapy lies in the need to quickly select an effective drug that acts on the maximum possible number of suspected pathogens, and also creates a high concentration in bone tissue.

Osteomyelitis is most often caused by staphylococci. The most severe course of the disease is associated with infection with Pseudomonas aeruginosa. In conditions of prolonged osteomyelitis, surgical operations, and concomitant diseases, microorganisms often become insensitive to broad-spectrum antibiotics, for example, to cephalosporins and fluoroquinolones.

Therefore, linezolid is preferred for empirical therapy. A less good choice would be vancomycin, since many bacteria become resistant to it over time.

Linezolid is administered intravenously. It is well tolerated. The most common side effects are nausea, loose stools and headache. The medicine can be used in children of any age; it has almost no contraindications. It is produced under the trade names Zenix, Zyvox, Linezolid. Amizolid and Rowlin-Routek are available in oral forms.

Vancomycin is administered intravenously. It is contraindicated in the first trimester of pregnancy and during breastfeeding, with neuritis of the auditory nerve, renal failure, and individual intolerance. The drug is produced under the trade names Vancomabol, Vancomycin, Vancorus, Vancocin, Vero-Vancomycin, Editsin.

In severe cases, the most modern antibiotics are used - Tienam or Meropenem. If the microbial association that caused the disease contains anaerobic microorganisms, metronidazole is added to therapy.

Before prescribing antibiotics, it is necessary to obtain material for microbiological testing. After obtaining the results of the sensitivity of microorganisms, the drug can be replaced with a more effective one.

The duration of the course of antibiotics is up to 6 weeks.

Sometimes treatment begins with broad-spectrum antibiotics that affect staphylococci:

protected penicillins;
cephalosporins;
fluoroquinolones;
clindamycin and others.

However, such treatment must be supported by data on the sensitivity of the isolated microorganisms.

Along with long-term antibacterial therapy, it is necessary to prevent intestinal dysbiosis using such agents as Linex, Acipol, and fermented milk products with live bacteria. If necessary, antifungal drugs (nystatin) are prescribed.

Folk remedies for bone osteomyelitis

After treating osteomyelitis in a hospital and discharging the patient home, some folk recipes can be used to prevent the transition to a chronic form or the development of an exacerbation:

make a decoction of oat grass (in extreme cases, oat bran will do) and make compresses from it on the sore limb;
make an alcohol tincture of lilac: fill a full three-liter jar of flowers or buds with vodka and leave in a dark place for a week, use for compresses;
take 3 kg of walnuts, remove the partitions from them and fill these partitions with vodka, leave in a dark place for 2 weeks; take a tablespoon three times a day for 20 days;
lubricate the affected area with aloe juice or make a compress from crushed leaves;
grate a large onion, mix with 100 g of laundry soap; Apply the mixture to the skin near the fistula at night.

Complications

Osteomyelitis can cause complications from surrounding tissues or the entire body. They are associated with the direct spread of infection, circulatory disorders, intoxication, and changes in metabolism.

A pathological fracture occurs at the site of sequestration due to minor trauma. In this case, the patient cannot step on his foot, abnormal mobility of bone fragments appears, and pain and swelling are possible.

Cellulitis is a diffuse purulent inflammation that can involve the bone, periosteum or surrounding muscles. The disease is accompanied by fever, intoxication, pain and swelling of the limb. Without treatment, it can lead to blood poisoning - sepsis.

Sepsis of the lower extremities.

When the ends of the bones are destroyed, pathological dislocation in the hip, knee, shoulder, elbow and other joints is possible. It is accompanied by a violation of the shape of the limb, pain, and the inability to move an arm or leg.

One of the common complications of osteomyelitis is pseudarthrosis. The free edges of the bone formed after surgery to remove a purulent focus do not fuse, but only come into contact with each other. In this place the bone remains mobile. There is dysfunction of the limb, pain in it, and sometimes swelling. Muscle weakness and atrophy occurs. Treatment for pseudarthrosis is quite long. The use of an Ilizarov apparatus is often necessary.

Ankylosis occurs when the articular surfaces of bones affected by osteomyelitis fusion, for example, due to long-term immobility of the limb. It is accompanied by a lack of movement in the joint.

As a result of excision of fistulas and compaction of surrounding tissues, joint contracture may develop - a decrease in its mobility.

Pathological fractures, false joints, ankylosis, contractures lead to deformation of the limb, the inability to walk or work with hands.

Arrosive bleeding may occur, accompanied by constant blood loss and the formation of an interstitial hematoma. Suppuration of the surrounding soft tissues leads to the development of diffuse purulent inflammation - phlegmon. This dangerous complication in some cases requires amputation of the limb.

In chronic osteomyelitis, the vessels and nerves passing near the bone are significantly affected. The blood supply to the final (distal) part of the leg or arm deteriorates, the tissues swell, and lack oxygen. Prolonged pain in the limb appears, possibly numbness and a feeling of tingling of the skin. Irritation by purulent discharge from the fistula leads to the development of dermatitis and eczema. When the skin becomes excessively dry, flakes, itchy skin occurs. If the patient begins to scratch the skin, secondary infection and suppuration often appear in the wounds.

In some cases, against the background of osteomyelitis, a malignant bone tumor develops - osteosarcoma, which has a high degree of malignancy and grows rapidly.

With a long course of osteomyelitis, metabolic processes in the body are disrupted. The tension of compensatory mechanisms leads to increased production of protein necessary for the healing of bone tissue. At the same time, pathological protein formations may appear, deposited in the kidneys and other organs. This is how a frequent complication of chronic osteomyelitis develops – amyloidosis. It is manifested mainly by symptoms of renal failure - edema, increased blood pressure, and impaired urination.

Pathogenic microorganisms from a purulent focus can enter any organ through the blood vessels, causing inflammation. One of the common common complications is pneumonia. The outer sac of the heart, the pericardium, is also affected. Blood poisoning – sepsis – often occurs.

Prevention

If a patient has risk factors for osteomyelitis, he should be aware of them. It is necessary to take all measures to prevent various infections, avoid cuts and scratches, and treat skin injuries in a timely manner. People with diabetes need to constantly monitor the condition of their feet to prevent skin ulcers from developing.

Dental caries, chronic tonsillitis, cholecystitis, and pyelonephritis should be treated in a timely manner. To increase the body’s nonspecific protection, it is necessary to monitor nutrition and physical activity, and lead a healthy lifestyle.

Osteomyelitis of the upper limb.

Osteomyelitis is an inflammatory process in the bone marrow that spreads to the surrounding bone substance. It can have an acute or chronic course and is manifested by bone pain, fever, intoxication, the formation of cavities and fistulas with purulent discharge. Treatment includes surgery and massive antibiotic therapy.

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The site is for informational purposes only. Do not self-medicate. If you notice any symptoms of illness, consult your doctor. The drugs presented on the site have contraindications; before use, read the instructions or consult a specialist.

Osteomyelitis of the hand

Causes of osteomyelitis

Osteomyelitis develops when bacteria enter bone tissue, periosteum, or bone marrow.

Contact osteomyelitis occurs when infection spreads to the bone from surrounding soft tissues in the presence of purulent lesions (abscess, phlegmon).

The following conditions contribute to the development of osteomyelitis:

Alcohol abuse, smoking, intravenous drug use;

Varicose veins and chronic venous insufficiency;

Frequent infections (3-4 times a year), indicating a deficiency of the immune system;

Impaired kidney and liver function;

Malignant diseases (tumors);

Previous splenectomy (removal of the spleen);

Elderly and senile age;

Low body weight, poor nutrition.

Symptoms of osteomyelitis

Diagnosis of acute hematogenous osteomyelitis in the early stages is difficult.

First aid for suspected osteomyelitis

Examination in hospital for suspected osteomyelitis

In the presence of an open purulent wound or fistulous tract, a culture of the purulent discharge from them is performed in order to determine the pathogen and its sensitivity to antibiotics.

The figure shows a typical x-ray picture of osteomyelitis - a cavity in the bone, a pathological fracture.

Treatment of osteomyelitis

Treatment of osteomyelitis is complex, possible only in a hospital setting in a trauma or surgical department, and includes conservative and surgical measures.

Conservative treatment methods include:

Detoxification therapy (intravenous administration of saline solutions and plasmapheresis, procedures for ultraviolet and laser irradiation of blood - purification of blood plasma from toxins);

Immunotropic therapy - the use of pharmaceuticals that increase the activity of the immune system (polyoxidonium);

Prescription of probiotics – drugs that normalize intestinal microflora. Due to massive antibacterial therapy, dysbiosis develops. To correct it, Linex and Bifiform are prescribed;

Prescription of drugs that improve blood microcirculation (pentoxifylline, trental);

Local treatment of the wound - dressings with antiseptic ointments (levomekol, levosin, 5% dioxidine ointment) and proteolytic enzymes (trypsin, chymotrypsin), which help cleanse and heal the wound.

Osteosynthesis using the Ilizarov apparatus

Possible complications of osteomyelitis

Complications of osteomyelitis can be local and general.

Local complications include:

Abscess and phlegmon of soft tissues - accumulation of pus and purulent impregnation of the soft tissues surrounding the affected bone;

Purulent arthritis - purulent inflammation of the joint located next to the osteomyelitic lesion;

Spontaneous fractures - occur at the slightest load due to loss of bone tissue strength;

Contractures – impaired mobility due to the formation of scars in the muscles surrounding the purulent focus;

Ankylosis – loss of mobility in joints affected by purulent arthritis;

Development of malignant tumors.

General complications include:

Sepsis – blood poisoning;

Secondary anemia - anemia, develops due to suppression of hematopoiesis against the background of chronic inflammation;

Amyloidosis is an autoimmune disease that primarily affects the kidneys and is difficult to treat.