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PubMed2001

[Acute osteomyelitis. Clinical, radiological and bacteriological features and outcome].

OBJECTIVE: To compare the clinical, radiological, bacteriological features and outcome of neonatal patients with acute osteomyelitis aged (28 days with those of children aged <= 28 days of age. PATIENTS AND METHODS: A retrospective analysis was performed. The clinical histories of patients aged less than 15 years diagnosed with acute osteomyelitis in a tertiary care hospital were reviewed. Acute osteomyelitis was defined as the association between at least two of the following variables: a) positive blood or biopsy culture; b) purulent bone aspiration; c) clinical features compatible with a diagnosis of acute osteomyelitis; d) radiological features suggestive of acute osteomyelitis, and e) favorable outcome after antibiotic treatment. The patients were divided into two groups: group 1: neonatal patients (aged (28 days) and group 2: children aged <= 28 days. Statistical analysis was performed by the Chi-square test and Student's t-test for categorized and numeric variables, respectively. RESULTS: Between 1977 and 1999, 45 children aged less than 15 years old were diagnosed with acute osteomyelitis. Of these, 17 patients were neonates (group 1) and 28 patients were aged more than 28 days old (group 2). The male:female ratio was 1.1:1 in group 1 and 3:1 in group 2. The mean age was 17.7 +/- 7.5 days in group 1 and 7.2 +/- 4.3 years in group 2. Metaphysis and tibia were more commonly affected in group 2 (p < 0.05). Epiphysis, arthritis and humerus were more frequently affected in group 1 (p < 0.05). Osteolysis and periosteal reaction predominated in group 1 (p < 0.05). 99mTc Bone scintigraphy and magnetic resonance imaging showed pathological findings in all patients. Blood culture revealed Staphylococcus aureus in 46 % of the patients. Blood and biopsy material cultures were positive in 46 % and 75 %, respectively. Of the 45 patients, outcome was favorable in 37 (82.2 %). CONCLUSION: Acute osteomyelitis showed different characteristics in the neonatal and postnatal periods. Bone scintigraphy and magnetic resonance showed high sensitivity. Bacteriology was positive in 50 % of patients.

Acute Disease↗
PubMed2001

Use of gracilis muscle free flap for reconstruction of chronic osteomyelitis of foot and ankle.

Despite low donor-site morbidity and a straightforward dissection, the gracilis muscle flap is still for many surgeons a second choice in microsurgical reconstruction of the lower extremity in cases of osteomyelitis. They underscore the difficulty of the procedure, and the problems of insufficient muscle volume and a small sized vascular pedicle. The aim of this study was to assess the reliability of the gracilis muscle free flap in the treatment of osteomyelitis of the foot and ankle. Between 1992 and 1999, 12 consecutive cases (age 9 to 71 years) of osteomyelitis of the foot and ankle were treated using a skin-grafted gracilis free muscle flap. Criteria for osteomyelitis were the presence of exposed bone, positive cultures and bone scans. The wound defect surface ranged from 9 to 90 cm2 (mean 50.5 cm2). Six flaps were applied on the weight bearing area of the foot. Flap harvesting time never exceeded 30 minutes. The mean follow-up is 15 months (range 2 to 60 months). All flaps survived completely. Secondary skin grafts were needed in two cases. One hematoma was noted at the flap donor site. Two patients (18%) had persistent osteomyelitis due to insufficient debridement in the presence of what appeared to be extensive bone involvement. Attempt to salvage the extremity was first performed but ultimately led to amputation. No patients complained of any donor site morbidity. Failure to cure the osteomyelitis was never caused by inadequate flap coverage. Gracilis muscle flap reliability in terms of vascular supply and ease of dissection made it our first choice in osteomyelitis of the foot and ankle. In the presence of extensive bone involvement, complex bone reconstruction is necessary to avoid amputation.

Adolescent↗
PubMed2002

MR imaging of neuropathic feet in leprosy patients with suspected osteomyelitis.

This study was undertaken to analyze MRI findings in leprosy patients with neuropathic feet, which are suspected of having osteomyelitis. As far as we know, there is no literature concerning osteomyelitis and MRI in neuropathic leprosy feet at present. Therefore, we have included MRI examination of 18 events of suspected osteomyelitis in 12 leprosy patients. All patients with long-standing neuropathic foot problems were clinically suspected of having osteomyelitis. All patients underwent the MRI protocol with the inclusion of Two Point Dixon Chemical Shift Imaging as a fat-suppression sequence. For the MRI evaluation, we used signs that are described in literature for detecting osteomyelitis in diabetic feet. The primary MRI signs were positive in 17 of 18 patients. The secondary MRI signs were positive in 100% of the patients. Our results show that MRI with the use of Two Point Dixon Chemical Shift Imaging is a promising diagnostic modality to detect osteomyelitis in the presence of neurosteoarthropathic changes in patients with leprosy. Whenever available, MRI could play an important role in detecting osteomyelitis in leprosy patients with long-standing neuropathic feet.

Aged↗
PubMed2004

Osteomyelitis in patients with systemic lupus erythematosus.

OBJECTIVE: To investigate the clinical profile of and the risk factors for osteomyelitis in patients with systemic lupus erythematosus (SLE). METHODS: We reviewed 11 consecutive cases of patients with SLE who had also had osteomyelitis between 1981 and 2001 at a medical center in Taiwan, with special attention to predisposing factors, clinical features, laboratory values, and outcomes. RESULTS: The mean age at diagnosis of osteomyelitis was 34.5 +/- 22.0 years and the ratio of females to males was 9:2. The typical initial manifestations were nonspecific focal pain (82%) and fever (64%). The most commonly affected sites were the long bones (6 cases, 54%), followed by the vertebrae (4 cases, 36%). Salmonella (5 cases, 45%) and Staphylococcus aureus (4 cases, 36%) were the major causative organisms. Interestingly, once long bones had become involved, 5 of 6 (83%) isolates proved to be Salmonella, and for vertebral osteomyelitis, 3 of 4 (75%) isolates proved to be S. aureus. Predisposing factors include an active status of SLE (SLEDAI score >/= 4, 100%), coexistent underlying systemic disease (91%), chronic renal disease (82%), and intensified immunosuppressive agent usage (82%). Laboratory values either reflected an acute phase reaction that would be expected in an infection, such as a raised C-reactive protein (100%) and neutrophilia (55%), or reflected features consistent with active lupus disease. Four patients had longterm motor deficits and another patient died. Poor prognostic factors include delayed diagnosis, vertebral involvement, artificial implants in bones, and chronic carrier status. CONCLUSION: In patients with SLE who present with local osteoarticular pain, particularly those whose disease is active and who also have chronic renal disease and were taking intensified immunosuppressive agents, osteomyelitis must be considered seriously. Salmonella should be considered as a potential contributing pathogen for long bone osteomyelitis and S. aureus should be considered for cases of vertebral osteomyelitis when conducting empirical antimicrobial therapy. Early recognition and treatment is essential to avoid longterm sequelae or death.

Adolescent↗
PubMed1991

Does hyperbaric oxygen have a place in the treatment of osteomyelitis?

There are several specific mechanisms by which HBO restores normal cellular processes that are compromised by hypoxia, or by which HBO augments bactericidal events. All of these are potentially applicable to, and beneficial for, the osteomyelitis patient. At the University of Texas Medical Branch, we find that early osteomyelitis is usually amenable to appropriate medical and surgical therapy. Adjunctive HBO is generally reserved for treatment of advanced stages of osteomyelitis (3B and 4B). In addition, HBO is occasionally used when patient circumstances dictate suppression of osteomyelitis rather than definitive treatment. Our clinical impression is that HBO has a beneficial effect on treatment outcome in these selected patients. Fault-free clinical studies are difficult to perform in this complex and varied patient population. Several studies have suggested a beneficial effect with the addition of adjunctive hyperbaric oxygen to usual osteomyelitis treatment regimens, whereas other clinical studies have failed to demonstrate such a benefit. No study has shown any harmful effect of adjunctive HBO on the outcome of osteomyelitis treatment. We hope that clinical researchers will continue to address this question, despite the research design problems inherent in the osteomyelitis population.

Clinical Trials as Topic↗
PubMedDate not supplied

Relationship of osteomyelitis and associated soft-tissue lesions with green liver discoloration in tom turkeys.

Tom turkey carcasses with partial green discolored livers (n = 191) or normal livers (n = 198) were examined for osteomyelitis and/or associated soft-tissue lesions. Seventy-nine turkeys with green discolored livers had osteomyelitis and/or associated soft-tissue lesions (41.4%), including 53 with just osteomyelitis (27.7%), while 112 (59.6%) had no osteomyelitis and/or soft-tissue lesions. Only five turkeys (2.5%) with normal livers had osteomyelitis. Discolored livers were significantly heavier, but carcasses with discolored livers weighed significantly less than carcasses with normal livers. Bacteria were isolated from 54 of 61 osteomyelitis lesions (88.5%); most frequently staphylococci (50.8%) followed by Escherichia coli (14.8%), Streptococcus sp. (13.1%), and occasional other organisms. Most associated soft-tissue lesions and livers were sterile (74.7%). These finding indicate that although turkey carcasses with green discolored livers are more likely to have osteomyelitis and/or associated soft-tissue lesions than turkey carcasses with normal livers, there is also an approximately equal chance they will not have these lesions.

Abattoirs↗
PubMed1990

[Clinical study of soaked treatment of chronic osteomyelitis with herbal medicine].

This paper represented 500 patients with chronic osteomyelitis who were treated with Chinese medicinal herbs, Gan-ling Immersion Formula, in which focuses were soaked in combination with other therapies from 1986-1989. Healing rate was 83.2%. Effective rate was 98.0%. This therapeutic method was more effective for treating chronic osteomyelitis of the hand and the foot with shorter course. It was also good for treating refractory skin ulcer and scar, ilium osteomyelitis and sclerosing osteomyelitis. This method was immediately effective for acute attack of chronic osteomyelitis. Fistula in half of the patients could be closed within two therapeutic course. Most of the non-union and delayed-union of the bones could be unionized as chronic osteomyelitis was healed. Most dead bones could remove spontaneously, some could be absorbable, and seldom should be removed by operating on. These herbs are easy to get. The method was so simple and so safe that it could provide a new way of treating chronic osteomyelitis. Experiments showed Gan-ling Immersion Formula possessed relative strong anti-inflammation and external antibiotic effects.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of osteomyelitis of the frontal bone and the walls of the frontal sinus].

Having in view observations made during surgical treatment of 21 patients with frontal bone osteomyelitis of traumatic (18 patients) and rhinogenic (3 patients) origin, three varieties of osteomyelitis can be distinguished, viz. osteomyelitis of frontal squama, osteomyelitis of frontal sinus wall, and mixed osteomyelitis involving nasal bones. Three therapeutic approaches are recommended: closed healing of the wound after dissecting the fistula and removal of osteomyelitic bone lesions, drainage of frontal sinuses via the frontonasal anastomosis, and tamponade of the cavity, that developed after the resection of the pathological focus, with the host muscle tissue. In advanced osteomyelitis of the frontal sinus walls, preference should be given to the neurosurgical approach with a wide revision of the pathological focus, removal of the mucosa, suppurative epidural layers and further formation of an enlarged frontonasal anastomosis and prolonged drainage of the cavity for 24 to 30 days. When treating osteomyelitis of frontal squama with its significant enlargement, the most efficient method is tamponade of the cavity formed by the hard membrane, skin and bone with the host muscle. Small osteomyelitic lesions of the frontal bone can be removed by dissecting the fistula, 3-4 day draining and suturing the wound.

Adolescent↗
PubMed1979

[Rare forms of chronic osteomyelitis in children (author's transl)].

4 cases of chronic osteomyelitis in children and adolescents are described. The first one concerns a girl with severe plasmacellular osteomyelitis of the right upperarm. As the treatment with antibiotics failed a partial resection of the right humerus, followed by plastic covering of the resulting defect was successful. Two further cases of chronic metatarsal osteomyelitis of both feet could be classified as a kind of "sclerosing osteomyelitis Garré", mostly corresponding to the clinical feature of the "chronic recurrent multifocal osteomyelitis" (Björkstén et al., 1978). Furthermore, a case of chronic ostitis localized in the symphyseal area is described, the clinical symptoms of which were resembling to the cortical osteoid, a special kind of sclerosing osteomyelitis. It is suggested that these different forms of chronic osteomyelitis in children are caused by bacterial infections. Nevertheless, this hypothesis remains to be proved. The problems of the differential diagnosis are discussed. Generally, the only therapy with antibotics is not successful, whereas the combination of removing of the inflammatory process with plastic covering of the bone-defect usually results in recovery.

Adolescent↗
PubMed1983

The technetium phosphate bone scan in the diagnosis of osteomyelitis in childhood.

We reviewed the technetium phosphate scans of 280 patients who had been referred with a clinical diagnosis of osteomyelitis in order to establish the diagnostic accuracy of this procedure. Strict criteria were established to define two subgroups: one of patients with proved osteomyelitis and one of patients who definitely did not have osteomyelitis. The scan correctly identified osteomyelitis at fifty-five of sixty-two sites, and was correctly negative in seventy-four of seventy-nine patients without osteomyelitis. The scan correctly distinguished all cases of cellulitis or soft-tissue abscess from osteomyelitis, but identified osteomyelitis in eight of thirty-nine patients with septic arthritis. The phosphate bone scan maintained this accuracy through any duration of symptoms, and performed almost equally well at all skeletal sites and in all age groups.

Abscess↗
PubMed1981

Osteomyelitis: microbiologic, clinical, and therapeutic considerations.

A distinction between "acute" osteomyelitis and "chronic" osteomyelitis is difficult on both clinical and histopathologic grounds. The classification of osteomyelitis into three groups (hematogenous osteomyelitis, osteomyelitis secondary to a contiguous focus of infection, and osteomyelitis associated with vascular insufficiency) allows the physician to clearly distinguish among the types of infection on the bases of (1) the pathogenesis, (2) the bones involved, (3) the microorganisms responsible, and (4) the therapy. When antimicrobial agents are administered to a patient with any form of osteomyelitis, a bactericidal antibiotic should be employed, if possible. If feasible, a parenteral route of administration should be utilized, and therapy should be administered for a prolonged period of time. When more than one bactericidal antibiotic has been demonstrated to be effective against the isolated microorganisms, the least toxic agent should be selected.

Adolescent↗
PubMed1994

[Computed tomography in the comprehensive radiologic diagnosis of chronic osteomyelitis of the lower extremities and pelvis].

The role of computed tomography in multimodality radiation diagnosis was assessed in the treatment of chronic osteomyelitis of the lower extremity and pelvis in 218 patients (128 with posttraumatic osteomyelitis, 46 with hematogenic osteomyelitis of long bones, and 19 with chronic pelvic osteomyelitis) aged 16-78 years. Computed tomography was used to specify the symptomatology of chronic osteomyelitis, to define indications for radical surgical treatment. The soft tissues of the shin were studied in patients with chronic osteomyelitis versus lymphedema in 103 patients, post-thrombophlebitic syndrome in 17, acute wound infection in 9. The symptomatology of osseous regenerate in distraction osteosynthesis was studied (120 computed tomograms). It has been indicated that computed tomography is effective in studying the chronic osteomyelitis-inflicted extremity and pelvis in the pre- and postoperative periods.

Adolescent↗
PubMed1993

The effect of wound environment on the incidence of acute osteomyelitis.

A model was developed to identify and compare the local wound factors that induce acute osteomyelitis in a prospective, controlled investigation. When compared with wounds containing either virulent bacteria or dead bone, statistical analysis disclosed a significant increase in the incidence of osteomyelitis when virulent bacteria and dead bone were combined. The incidence of osteomyelitis in wounds containing an inoculated, hematoma-filled dead space was significantly less when compared with wounds containing dead bone and virulent bacteria. The incidence of osteomyelitis is significantly less when a nonvirulent strain of bacteria is substituted for a virulent strain. Although rigid internal fixation increased the incidence of osteomyelitis to 100% and long-term antibiotic therapy decreased the incidence, these changes were not statistically significant. These data allow the authors to predict the relative risk of osteomyelitis when these wound factors are present. The prevention of osteomyelitis depends on the clinical identification and modification of these local wound factors.

Acute Disease↗
PubMed1977

Radionuclide imaging. Use in diagnosis of osteomyelitis in children.

Forty-four children were studied for the presence of osteomyelitis by scintigraphy using Tc 99m etidronate tin complex. Evidence of osteomyelitis on radionuclide images was found in 16 of 19 patients considered to have osteomyelitis by their attending physicians. Bone scintigraphic changes were noted prior to or in the absence of roentgenographic abnormalities in 10 of 19 patients. Cases of acute hematogenous osteomyelitis, chronic osteomyelitis, and osteomyelitis caused by penetrating trauma and contiguous infection were identified. Three bone infarctions were correctly diagnosed.

Bone Diseases↗
PubMed1992

Photopenic defects in marrow-containing skeleton on indium-111 leucocyte scintigraphy: prevalence at sites suspected of osteomyelitis and as an incidental finding.

The skeletal distribution of red marrow-containing sites with a decreased uptake of indium-111-labelled leucocytes was examined as part of a retrospective review of 128 consecutive scans in 113 patients. The prevalence of photopenic defects was determined for sites of suspected osteomyelitis and for other skeletal locations included as part of limited or total-body surveys. Of 52 sites suspected of osteomyelitis based upon radiological and clinical data, 21 (40%) demonstrated a decreased leucocyte uptake. The prevalence of photopenia ranged from 79% (11/14) in the spine and 63% (5/8) in the pelvis to 25% (4/16) in the proximal femur and 0% elsewhere in the extremities (0/9) and in the skull (0/3). Fourteen of these 21 defects (67%) were due to active (n = 9) or healed (n = 5) osteomyelitis/discitis. All sites of active osteomyelitis showed destructive changes on correlative radiographs and were associated with infectious processes of more than 1 months duration. Thirty-seven photopenic defects were observed as incidental findings. The prevalence of photopenia as an incidental finding ranged from 0% in the skull, neck and chest to 3%-4% in the thoracolumbar spine and pelvis and 14% in the femoral heads, the latter reflecting primarily bilateral loss of femoral head marrow. No incidentally found photopenic defect reflected active osteomyelitis. At sites in the spine and pelvis with radiologic evidence of bone destruction suggestive of osteomyelitis, an absence of normal red marrow uptake of labelled leucocytes often reflects a variant presentation for active chronic infection. In contrast, incidental photopenia is uncommon at all skeletal sites except the femoral heads, and should not raise concern over unsuspected active osteomyelitis.

Bone Marrow↗
PubMed1994

Ultrasonic signs of pelvic osteomyelitis in children.

The ultrasonic findings were reviewed in 13 children in whom pelvic osteomyelitis was diagnosed by a positive 99mtechnetium methylene diphosphonate (MDP) bone scan in conjunction with clinical and laboratory features of osteomyelitis. All patients presented with pain in the region of the hip joint. In six patients the ultrasound study was confined to the hip joint, and all six had normal findings. In seven patients the ultrasound study was extended to include the pelvis. Deep soft tissue swelling was demonstrated in six of these, including a periosseous abscess in one case. Ultrasonography was negative in one patient with a 5-week history, whose pelvic osteomyelitis was resolving at the time of the ultrasound study. Oedema of the obturator internus and externus muscles was observed in osteomyelitis affecting the pubis and ischium, and of the iliacus and/or the gluteus medius muscle in osteomyelitis of the ilium. In children presenting with hip pain who have a normal hip ultrasound study, extension of the ultrasound examination to include these four pelvic muscles may help to identify and document the progression of acute pelvic osteomyelitis.

Adolescent↗
PubMed1998

[Nonbacterial osteomyelitis of the clavicle].

Osteomyelitis can be subdivided into a bacterial exogenic (post-traumatic/postoperative), bacterial endogenic (hematogenous) and an abacterial type, including the rare group containing primary chronic sclerosing osteomyelitis, which is typically localized in the clavicle. In a review of the literature, the criteria for the various types of chronic sclerosing osteomyelitis are analyzed. Out of a group of 17 patients with osteomyelitis of the clavicle treated between 1978 and 1996, three cases of primary chronic sclerosing osteomyelitis are demonstrated. In the differential diagnosis, primary chronic sclerosing osteomyelitis of the clavicle has to be taken into consideration despite its rareness. After establishing a diagnosis by biopsy, in contrast to the other forms, drug therapy will be the treatment of choice and not an operation.

Adolescent↗
PubMed1996

[Diagnostic imaging in osteomyelitis. Characteristics in childhood].

The prognosis of acute hematogenous osteomyelitis in children is mainly influenced by early diagnosis and prompt initiation of antibiotic and surgical therapy. In this age group, two forms of manifestation are differentiated: osteomyelitis in infants up to 18 months and juvenile osteomyelitis until the closure of the epiphyseal plate. Osteomyelitis in infants is often accompanied by septic arthritis of the adjacent joint. In juvenile osteomyelitis, the disease is mostly confined to the metaphysis. Plain films and ultrasonography represent the basic imaging modalities. Depending on the age of the child, the clinical course of the disease and the availability of the various methods, MRI and multiphase bone scintigraphy can be performed for further imaging. CT is of only limited value and should only be used for special cases concerning chronic osteomyelitis.

Acute Disease↗