This document discusses chronic osteomyelitis, a bone infection that lasts longer than 6 weeks. It describes the pathogenesis, presenting complaints, diagnosis, investigations, treatment, and complications of chronic osteomyelitis. There are three main types: secondary to acute osteomyelitis, Garre's osteomyelitis, and Brodie's abscess. Diagnosis involves clinical examination and radiological confirmation showing bone changes. Treatment primarily involves surgery to remove dead bone tissue followed by antibiotics. Complications can include exacerbations, bone deformities, and pathological fractures.

1. Chronic osteomyelitis
Name: Nur Aisyah Binti Idris
Matrix no.: 082012100068

2. Contents
Pathology
Presenting Complaints
Diagnosis
Investigation
Treatment
complication

3. Chronic osteomyelitis
• Used for chronic pyogenic osteomyelitis
• the bone infection >6week after an injury,
initial infection, or the start of an underlying
disease.
• 3 types:
–Chronic osteomyelitis secondary to acute
osteomyelitis
–Garre’s osteomyelitis
–Brodie’s abscess

4. Pathogenesis
Inadequate treatment of acute OM /Foreign
implant /Open fracture
Persistent infection in the bone leads to increase in
intramedullary pressure due to inflammatory
exudates (pus) stripping the periosteum
Bone necrosis (Sequestrum formation)
New bone formation occur (Involucrum)
Multiple openings appear in this involucrum,
through which exudates & debris from the
sequestrum pass via sinus tract formation

5. Type of sequestra
Type Disease
Tubular Pyogenic
Ring External fixator
black Actinomycosis
Coralliform Perthe’s disease
Coke Tuberculosis
Sandy tuberculosis
Feathery Syphilis

6. Presenting complaints
• Chronic discharging sinus
• Sinus heals, reappear with each acute
exacerbation
• Discharge seropurulent-thick pus
• Pain  minimal, aggravated during AE
• Generalised symptomsfever
• Present with complication

7. Diagnosis
• Suspected clinically
• Confirmed radiologically
• Examination:
• Chronic discharging sinus
• Thickened irregular bone
• Tendernes on deep palpation
• Adjacent joint may be stiff

8. Investigation:
• Radiological
examination
– Thickening & irregularity
of the cortices
– Patchy sclerosis
– Bone cavity
– Sequestrumdenser
– Granulation tissue
radiolucent
– Involucrum & cloaca
• Sinogram: help localise
where pus is coming
from
• Ct scan & MRI: better
defining the cavity &
sequestra
• Pus culture: help in
selecting the antibiotics

9. Differential diagnosis
• Tubercular osteomyelitis
• Soft tissue infection
• Ewing’s sarcoma

10. Treatment
• Principle treatment: surgical
• Antibiotic during AE & post-op period
• Aim:
– Removal of dead bone
– Elimination of dead space and cavities
– Removal of infected granulation tissue & sinuses

11. Operative procedure
• Sequestrectomy
• Saucerization
• Curretege
• Excision of infected bone
• Amputation
 After surgery, wound is
closed by continous
suction irrigation system
 For 4-7 days

12. Complication
• Acute exacerbation
• Growth abnoralities
– Shortening
– Lengthening
– Deformities
• Pathological fracture
• Joint stiffnes
• Sinus tract malignancy
• Amyloidosis

13. Garre’s osteomyelitis
• Sclerosing, non-supurative chr. Osteomyelitis
• Commonly : shaft of femur/tibia
• Acute local pain, pyrexia & swelling
• Fusiform osseous enlargement persist
• Tenderness on deep palpation
• No discharging sinus
• Commonly present with similar features:
Ewing’s & osteosarcoma
• Treatment: guarded, rest, BS antibiotics,
gutter&holes in bone

14. Brodie’s abscess
• Special type of
osteomyelitis: body’s
defense mechanism able
to contain the
infectioncreate a chr.
Bone abscess containg pus
& surrounded by zone of
sclerosis
• CF:
– 11-20 yr, upper end tibia &
lower end femur
(metaphysis), deep boring
pain, worse at night & on
walking,relieved by rest
• Examination: tendernes &
thickening of bone
• Radiological features: oval
lucent area surrounded
by zone of sclerosis
• Treatment: operation
(surgical evacuation &
currettage), cavity large(
pack with cancellous
bone chips)

15. Thank you 