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Chronic osteomyelitis

  • Develops because of following reasons:
  • Delayed and inadequate treatment.
  • Type and virulence of organism
  • Reduced host resistance

Persistence of Infection

Destruction of Cancellous Bone

Necrosis of Part of Bone (Sequestra)

Host Response Subperiosteal New Bone Formation

  • This new bone is known as INVOLUCRUM.
  • It may have holes in it known as CLOACAE, for drainage of pus
  1. Hallmark of Chronic Osteomyelitis
    1. Sequestrum
    2. Involucrum
    3. Cloacae
    1. Chronic discharging sinus.
    2. Thickened irregular bone.
    3. Tenderness
    4. Stiff adjacent joint
  3. Diagnosis
    1. Gold Standard: Biopsy
    2. For Histological and Microbiological evaluation of bone.
  4. X-Rays
    1. Thickening and irregularity of cortices.
    2. Sequestrum
    3. Involucrum
    4. Cloacae
  5. Sequestrum “DENSER” than surrounding bone
    1. Normal calcium metabolism does not take place, because of Avascularity.
    2. Surrounded by Granulation Tissue.
    3. Surrounded by a Cavity.
  6. CT- SCAN
    1. Very helpful in Chronic Osteomyelitis, helps in assessing the location Sequestrum.
    2. Helps in assessing Involucrum.
  7. Treatment
    1. Sequestrectomy
    2. When should we do
      1. Wait for proper involucrum to form
      2. Don’t cause pathological fracture.
    3. Saucerization
    4. Convert Infected Site Into Saucer, Allow For Free Drainage.
    5. Can Be Supplemented With Continuous Suction And Drainage.
  8. Complications
    1. Acute exacerbation
    2. Growth abnormalities
    3. Pathological fracture
    4. Joint stiffness
    5. Sinus tract malignancy- squamous cell carcinoma.
    6. Amyloidosis

Description: Description: Copy (3) of Dsc00294

Chronic ostemyelitis of tibia with sequestrum

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