Osteomyelitis
Description
- Infection of bone and marrow -> inflammation, vascular compromise, bone necrosis (sequestrum) and new bone formation (involucrum)
- Sequestrum is avascular -> antibiotics do not reach it -> surgical debridement, not longer antibiotics, is what cures chronic disease
Classification - by route
| Features | |
|---|---|
| Haematogenous | Children: metaphysis of long bones (slow sinusoidal flow). Adults: vertebral body |
| Contiguous spread | Diabetic foot ulcer, pressure injury, dental, sinus, chronic wound |
| Direct inoculation | Open fracture, surgery, prosthetic joint, penetrating trauma |
By chronicity
- Acute - days to weeks; systemic features; no sequestrum yet -> antibiotics may cure without surgery
- Chronic - sequestrum, involucrum, sinus tract, recurrent flares; surgery is almost always required
Anatomical (Cierny-Mader)
- I medullary / II superficial / III localised (full-thickness, stable) / IV diffuse (unstable)
- Modified by host: A normal, B compromised (local or systemic), C treatment worse than the disease
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