Complication Of Osteomyelitis Research Articles

Subperiosteal abscess in children: scintigraphic appearance.

A subperiosteal abscess is an uncommon complication of osteomyelitis in childhood. Bone scanning is very sensitive for the detection of early skeletal infection; however, a subperiosteal abscess has a different and distinctive scintigraphic appearance. The usual increased tracer uptake of osteomyelitis is overshadowed by the presence of a "cold" lesion on the delayed views, probably due to interruption of the vascular supply of the bone. Early recognition of the condition is important, as surgery is indicated to prevent extensive bone necrosis and chronic osteomyelitis. In suspected osteomyelitis, a central photopenic area is highly suggestive of subperiosteal abscess; when such an area is seen, a computed tomographic (CT) scan can be helpful in planning the surgical approach for drainage. Plain radiographs may be unremarkable even when the bone scan and CT findings are dramatic. Five such cases are presented, and a recommended diagnostic approach is discussed that views the two procedures as complementary.

Chronic complicated osteomyelitis of the lower extremity: evaluation with MR imaging.

Preoperative magnetic resonance (MR) imaging examinations were performed with a 1.5-T superconducting magnet in 14 patients who had extensive deformities of the bones and soft tissues of the lower extremities due to previous trauma, surgery, and chronic infection. This retrospective study assessed the diagnostic performance of MR imaging in determining the presence and extent of active bone and soft-tissue infections. The presence and extent of active osteomyelitis were confirmed by reviewing the clinical, surgical, histologic, and microbiologic records of all patients. Of the 14 MR imaging examinations, 11 were true-positive, two were true-negative, one was false-positive, and none was false-negative. In the indium scans obtained in this group of patients, five were true-positive, three were true-negative, none was false-positive, and three were false-negative. In two amputated extremities, close correlation was found between the extent of disease seen on surgical and pathologic examination and that demonstrated by MR imaging, which could delineate the course of sinus tracts. MR imaging was therefore helpful in assessing the activity of chronic complicated osteomyelitis and beneficial in surgical planning for these patients.

Nonunion

The recognition and treatment of delayed union or nonunion of a fracture is an orthopedic salvage procedure that all veterinary surgeons eventually experience. The major factor in determining whether a fracture becomes a nonunion or goes on to unite is the degree of stabilization of the fracture site. Infection (osteomyelitis) also contributes significantly to the formation of a nonunion. Nonunions can usually be classified clinically and radiographically as either vascular (capable of biologic activity) or avascular (incapable of biologic activity). Once this determination has been made, treatment regimens include application of rigid internal fixation (vascular nonunions) and installation of autogenous cancellous bone grafts after decortication (avascular nonunions). With the complication of osteomyelitis, microbiologic evaluation and antibiotic therapy should be considered even though a fracture will heal in the presence of infection if it is stable.

Imipenem/cilastatin in the treatment of osteomyelitis

Thirty-four patients with osteomyelitis were treated for a mean of 32.5 days with 2 to 4 g per day of imipenem/cilastatin. Twenty-six infections involving the lower extremities were associated with accidents and prosthesis implantation, and 19 of 34 patients had more than one organism isolated. Gram-positive and gram-negative organisms were equally represented, but follow-up bone culture samples showed only 11 percent of gram-positive organisms persisted versus 23 percent of gram-negative organisms. Seventy-four percent of patients were cured or improved, and failures were related to resistant organisms and the inability to perform adequate surgical debridement. Adverse drug side effects included nausea, diarrhea, liver enzyme elevations, and neutropenia, but discontinuation of treatment was required in only three patients. Imipenem/cilastatin holds promise as monotherapy in complicated polymicrobial osteomyelitis.

Eikenella corrodens in human bite infections of the hand.

Over a 51/2-year period 30 patients were found with Eikenella corrodens infections of the hand following closed fist injury. Twenty-four had mixed infections; six grew pure cultures of Eikenella. Twenty-one of the 30 patients had positive cultures from an injured metacarpophalangeal joint. A delay in presentation or an inaccurate initial diagnosis appeared to be the most significant factors leading to the complications of osteomyelitis (in five patients) and significant loss of joint function (in eight other patients). Clinicians must have a high index of suspicion when evaluating any hand injury and clenched fist injuries of the hand should be treated by early adequate surgical debridement followed by IV penicillin given until operative cultures confirm or deny contamination with Eikenella corrodens.

Acute haematogenous osteomyelitis in infancy and childhood.

Chronic osteomyelitis is recognised as a very old disease, but acute osteomyelitis appears to have been understood only in the last 50 or so years. Until the latter part of the nineteenth century, acute osteomyelitis was only rarely recognised, except as a complication of open fractures or local sepsis. According to Wilensky (1927) the term osteomyelitis was probably coined by Nelaton in 1844. Acute osteomyelitis has always been a serious disease because of the risk to the life of the patient as well as its tendency to chronicity and recurrence. Recent improvements in surgical care and chemotherapy have made it less

Avascular necrosis of the capital epiphysis following osteomyelitis of the proximal femoral metaphysis.

1. Attention is drawn to the danger of avascular necrosis developing in the capital femoral epiphysis as a complication of osteomyelitis in the intertrochanteric region. 2. This necrosis is commonly aseptic. It is believed to be caused by compression or thrombosis of the epiphysial vessels. 3. The situation will be aggravated if infection spreads to involve the joint. 4. We believe that prompt decompression of both the joint and the bone is indicated in order to reduce the incidence and severity of these complications.

OSTEOMYELITIS OF THE SUPERIOR MAXILLA: TREATMENT WITH PENICILLIN

It is well known that osteomyelitis of any bone of the skull is fraught with great danger to life, secondary to extension of the lesion throughout the cranium. In a previous article on osteomyelitis, 1 under the heading Conclusions, the following statements were made: One may expect any osteomyelitic lesion in the skull to cover pachymeningitis or to be complicated by an abscess of the brain. The first surgical step in the treatment of these two frequent complications of osteomyelitis is removal of the foci of infection.... The importance of general supportive treatment and measures to increase resistance cannot be overestimated. Today otolaryngologists must add chemotherapy to their armamentarium. I still maintain that it is always desirable, when possible, to limit the infection of bone to its orignal site. Extensions are often difficult to determine in early stages, and consequently in the past surgeons have been compelled to advocate radical surgical

DIABETES INSIPIDUS AND OTHER UNUSUAL COMPLICATIONS OF ACUTE PURULENT SINUSITIS

The neurologic complications of infection of the paranasal sinuses are numerous and include pachymeningitis externa and extradural abscess, pachymeningitis interna and subdural abscess, circumscribed leptomeningitis, protective meningitis, bacterial meningitis, brain abscess, nonsuppurative encephalitis, thrombophlebitis of the intracranial venous channels and involvement of many cranial nerves. These complications present frequently perplexing diagnostic and therapeutic problems, defying the combined efforts of the otorhinologist, the ophthalmologist and the neurologist. The reasons for these difficulties have been discussed previously by one of us (Yaskin1). In the case to be discussed in this paper there occurred, in addition to the rather common basilar meningitis, the unusual complications of osteomyelitis of the lesser wing of the sphenoid bone, rapidly progressive optic neuritis, partial thrombotic occlusion of one of the middle cerebral arteries, changes in the hypothalamus and transient diabetes insipidus. In addition, the type of cortical destruction produced by occlusion of the middle cerebral artery

POSSIBLE DEDUCTIONS OF ENDOCRINE SIGNIFICANCE FROM ROENTGENOGRAMS OF THE SINUSES AND MASTOID

The aim of this paper is to present a preliminary treatise on three problems of endocrine background closely allied to otolaryngology. These are: Does pituitary activity exert any influence on the susceptibility of the petrous pyramid to infection? What can the otolaryngologist tell of his patient's intelligence quotient by roentgenograms of the sinuses and mastoid? Do the characteristics of the skull observed in cases of hyperpituitarism predispose to the complication of osteomyelitis in cases of frontal sinusitis? DOES PITUITARY ACTIVITY EXERT ANY INFLUENCE ON THE SUSCEPTIBILITY OF THE PETROUS PYRAMID TO INFECTIONS? The work of Hector Mortimer and his associates on cranial dysplasias of pituitary origin1presents a division of human craniums into four groups, according to pituitary levels. Levene, Johnson, Lowman and Wissing2described the four types thus: Type 1. Overactivity of the anterior lobe produces an expansion of the trabecular network of bone. It may be likened to the

Unusual complications of osteomyelitis

The fact that these malignancies are usually engrafted on an old ulcer, does little to alarm the patient already inured to his osteomyelitis. Usually the disability here is slight or nil. The patient disregards the slight increase in symptoms and just “drops in” to the clinic for a checkup. The findings of chronic discharge, foul odor, pains of a mild nature, the clinical appearance of the lesion and a biopsy report furnish evidence enough that surgery must be instituted. The two cases showing the relatively short drainage period, should impress one with the probability that a low grade osteomyelitis may exist for many years, with an exciting factor such as trauma or infection as the inciting cause. It is hardly conceivable that lowered skin resistance would be a predisposing factor in the malignancies, since perfectly normal skin was present before any clinical appearance of the lesions. It is quite possible that in the other five cases the continued irritation, and poor skin resistance would lead to infection and malignancy. The patients who developed the toxic neuritis show a latent period between the acute onset of the osteomyelitis and the primary surgical intervention during which deafness started, continued and was not arrested nor helped by the treatment of the osteomyelitis. The treatment of skin malignancies by amputation or by wide curettement of the involved parts insures a good result. The first of the toxic neuritis patients developed a brain abscess and succumbed; the second is still living with a complicating amyloidotic condition.