Sclerosing osteomyelitis Garre is a rather rare, but very dangerous disease of the musculoskeletal system. This defect was first described in detail at the end of the 19th century. This problem is faced mainly by men at a young age. Pathology refers to atypical types of osteomyelitis, in the absence of appropriate therapy, it can lead to extremely serious complications in the form of phlegmon and abscess.
Etiology
The skeleton of each person consists of spongy, tubular and flat bones. Each of them contains bone marrow. With Garre osteomyelitis, the pathological process can cover any area of the skeleton. Purulent inflammation of the bone marrow is characteristic of this anomaly, while the periosteum, spongy and compact substance is affected.
This disease is called sclerosing because connective tissue grows due to inflammation. As a result, the bones become thicker in the diaphysis zone.
This pathology is most often detected in representatives of the stronger sex at the age of 20-30 years. Although it is often diagnosed in children.
If the necessary treatment is absent, then the risk of sepsis, and even death, is extremely high. In adult patients, such negative effects of Garre osteomyelitis (according to ICD-10 - M86.8) rarely develop.
Classification
Most often, the pathological process covers the femur. It is noteworthy that with this disease fistulas and purulent cavities do not form. There are several varieties of osteomyelitis Garre:
- post-traumatic;
- contact;
- hematogenous;
- gunshot;
- postoperative.
This defect belongs to the category of primary chronic forms of pathology. Osteomyelitis of the tubular bones can be total, epiphyseal, diaphyseal and metaphyseal.
Reasons for the appearance
Garre osteomyelitis is provoked by opportunistic microorganisms. Most often, Klebsiella, Staphylococcus and Streptococcus act as pathogens. Much less often, sclerosing osteomyelitis is provoked by fungi, pseudomonads, clostridia, bacteroids and fusobacteria. Bacteria enter the bone marrow and tissue through the bloodstream or damaged areas of the skin.
The provoking factors include:
- fractures
- tuberculosis;
- weakened immunity;
- gunshot wounds;
- phlegmon;
- adenoids;
- caries;
- surgery for joints and bones;
- the presence of pyoderma;
- inflammation of the tonsils of a chronic form.
Starving and weakened people are at risk for a long time. Purulent inflammation can develop due to frostbite and burns. In addition to the penetration of pathogenic microorganisms, respiratory pathologies, stresses, unhealthy nutrition, increased physical activity and hypothermia contribute. Sometimes osteomyelitis appears in infants. The reasons for this can be infectious diseases of the expectant mother during pregnancy.
Symptomatology
The symptoms of Garre osteomyelitis are not specific. Most often, patients complain of:
- feeling unwell in general;
- increased body temperature;
- slight weakness, fatigue;
- headache;
- limited movement;
- mild swelling of the extremities;
- dull pain in the damaged bone.
Leakage features
Most often, the pathology covers the legs. A feature of chronic sclerosing osteomyelitis Garre is considered to be a multiple increase in the intensity of symptoms at night. For example, many patients notice tachycardia. At the same time, the heart rate is more than 80 beats per minute.
Pain in osteomyelitis is predominantly local. Usually they are weak and dumb. The pain intensifies many times against the background of physical exertion.
Sometimes the process affects the humerus, radius and ulna. No less common is the osteomyelitis of Garre's lower jaw. In addition, cases of purulent inflammation of the shoulder blades, ribs and pelvis are known to medicine.
Chronic osteomyelitis gradually entails an abnormal change in the shape of the bones. Over time, their deformation occurs. Shortening and curvature of the limb is equally likely. Pathology proceeds with variable periods of exacerbations and remissions.
Purulent inflammation may be common or local. In the first case, the appearance of metastatic lesions is likely. Diagnosis of Garre's osteomyelitis is possible only after an x-ray.
Probable complications
Osteomyelitis Garre in the absence of proper treatment can lead to very dangerous consequences. The following complications are likely:
- sepsis;
- purulent arthritis;
- contracture;
- spontaneous fractures;
- ankylosis;
- the appearance of false joints;
- phlegmon;
- renal amyloidosis;
- anemia;
- bone deformation;
- malignant tissue transformation;
- pyelonephritis.
The most dangerous is the generalized type of disease. This form can cause damage to the kidneys, lungs and heart. There is a risk of nephritis, pericarditis, pneumonia, myocarditis and acute heart failure. Inflammation of the brain is also possible. Atypical signs of a defect include headache, cramps, petechial rash, and impaired consciousness.
Diagnostics
It is worth saying that any therapy is carried out only after confirmation of the diagnosis. To do this, you need:
- densitometry;
- Ultrasound
- MRI
- bone slices analysis;
- biochemical and general blood tests;
- puncture;
- bacteriological examination;
- general urine analysis;
- radiography;
- CT
Garre osteomyelitis can be determined by elevated levels of bilirubin and transaminases in the blood, a reduced number of red blood cells and hemoglobin, as well as too many platelets. Also, leukocytosis and an acceleration of ESR may indicate the presence of the disease. Abnormal changes in urine levels may indicate kidney damage. To identify the type of pathogen, puncture is required.
The simplest and most informative method of examination is radiography. In the pictures with this disease, you can consider the thickening of the diaphysis of the affected bone and its spindle-shaped deformation. Marked sclerosis is noted.
Prognosis and treatment of osteomyelitis Garre
After detecting the pathology using radiography, a therapeutic regimen is selected. She may be conservative. Most often, doctors recommend antibiotics from several different pharmacological categories to their patients. It is supposed to enter them inside the affected bone. It is this method of application that makes it possible to quickly achieve the necessary concentration of active substances that have a beneficial effect. If the patient complains of frequent bouts of pain, pain medications are prescribed.
With osteomyelitis, Garre is advisable to use:
- vitamin complexes;
- medical exercises;
- physiotherapeutic procedures;
- minerals that strengthen bone tissue.
If symptoms of the disease are detected, surgery may be indicated. This operation is aimed at eliminating the purulent focus. Necrectomy is usually performed. After removal of the purulent focus, bone grafting may be necessary. Some patients are additionally shown a resection of the damaged area.
Surgery in some cases is difficult. When complications in the form of sepsis occur, lymphosorption and hemosorption are carried out. In the event of a diagnosis of joint inflammation, an arthrotomy may also be necessary.
All patients with a diagnosis of sclerosing osteomyelitis Garre must constantly drink as much fluid as possible, eat a lot of fruit vegetables, and also replenish the daily menu with the maximum amount of foods rich in phosphorus and calcium. At the same time, it is very important to introduce a fractional diet - to eat in small portions 5-6 times a day.
In general, the further prognosis depends on the form of the disease, the age of the patient, as well as the timeliness of diagnosis and therapy. Chronic osteomyelitis implies mandatory surgical intervention. Only in this way can the patient expect a full recovery soon. An indispensable condition for successful therapy is also considered unquestioning compliance with all the doctor's prescriptions. So, after surgery, patients are shown a therapeutic diet, a fractional diet, drinking regimen and complete rest. Patients should abandon physical activity and overwork.
Conclusion
In fact, sclerosing osteomyelitis Garre is considered a dangerous disease and can lead to serious complications. Only with timely and competent treatment can one count on a positive prognosis and a speedy recovery.