Osteomyelitis is a purulent infection that affects the bone marrow of the bone tissue, as well as the periosteum. Post-traumatic osteomyelitis (according to ICD-10 code M86) is considered a serious disease that occurs after a bone injury or after any kind of surgery. This disease can affect men and women at any age.
Description of the disease
Post-traumatic osteomyelitis occurs when open fractures occur. Its cause is contamination of the wound in the presence of injury. The more difficult the fracture is, the more chances there are for the development of such a disease. As a rule, all bone sections are affected.
In the event that the fracture is linear, the affected area becomes inflamed, and if the injury is comminuted, the purulent process can spread through the tissues. The disease is accompanied by severe intoxication along with hectic fever, an increase in ESR, leukocytosis and anemia. The wound area can be swollen and very painful, a large amount of pus comes out of it.
Next, we proceed to consider the causes of a disease such as post-traumatic osteomyelitis.
Reasons and features
The cause of this disease are pathogenic bacteria and microscopic organisms that cause purulent inflammation in the bones. Most often they are staphylococcus aureus. Microorganisms usually enter the bone and cartilage during a cut, fracture, or injury. The following types of osteomyelitis are distinguished: post-traumatic form, gunshot type, contact and postoperative.
Any open injuries along with fractures can lead to purulent inflammation if the wound has not been properly treated. The most vulnerable areas of the human body are those in which the bones are practically not protected by soft tissues.
For example, very often there is post-traumatic osteomyelitis of the lower jaw. With a fracture, inflammation usually occurs only on the affected area. In the presence of numerous injuries and fractures, purulent processes can capture not only the bone with the periosteum, but also spread to the area of soft tissues.
Gunshot osteomyelitis may result from infection of a wound amid a corresponding wound. Most often, the bone is affected due to significant injuries, multiple injuries and displacement of bone fragments.
Postoperative osteomyelitis can occur when a wound is infected as part of a surgical procedure. Despite disinfection, pathogens that are resistant to drugs can remain in the human body. In addition, suppuration can occur after the introduction of the spokes, and, in addition, as a result of the imposition of skeletal traction or compression and distraction apparatus. This is the so-called spoke osteomyelitis, which is a type of disease (post-traumatic osteomyelitis of the lower leg, for example).
Contact osteomyelitis is a consequence of the spread of pathogens into the soft tissues. Bacteria enter the bone marrow canals from adjacent areas of infection. Such foci are ulcers on the body along with abscesses, phlegmons, dental pathologies and the like. This type of disease is often found in children.
At risk are those who lead an asocial lifestyle, and, in addition, people who are physically weak, as their weakened immune system is not able to fight bacteria that penetrate the human body.
Infections
The causes of post-traumatic osteomyelitis may be the transfer of one of the infections. For example, due to a sore throat, a festering tooth, inflammation in the middle ear, furunculosis, furuncle, panaritium, purulent skin diseases, an inflamed navel ring, pneumonia, scarlet fever, measles and other infectious pathologies.
Risk group
At risk are primarily those who abuse smoking, alcohol and drugs (through the veins). It also often leads to this disease, low weight, along with poor nutrition and advanced age. This disease is sometimes a complication due to other health troubles. For example, due to a violation of immunity, the presence of vascular atherosclerosis, and, in addition, due to the influence of the following factors:
- the patient has varicose and venous deviations;
- against diabetes, due to functional hepatic or renal impairment;
- in the presence of malignant tumors, as well as due to removal of the spleen.
Now we will understand what symptoms accompany the occurrence of this pathology. Case reports for post-traumatic osteomyelitis are of interest to many.
Symptoms of this pathology
Post-traumatic osteomyelitis may be associated with certain symptoms. This disease most often proceeds in a chronic format.
The main signs of chronic post-traumatic osteomyelitis are the following manifestations:
- the occurrence of redness and swelling of the affected area of the body;
- the appearance of painful sensations and purulent discharge during palpation;
- fistula formation and fever;
- significant deterioration in general condition and well-being;
- the occurrence of sleep disturbances;
- the occurrence of weakness and lack of appetite.
Blood tests reveal a high erythrocyte sedimentation rate along with increasing leukocytosis and anemia. The acute form of the disease is characterized by symptoms in the form of severe destruction of bone tissue, significant blood loss, a sharp decrease in the body's defenses and an increase in temperature to febrile values. Severe pain can occur in the area of the fracture, and pus liberates abundantly from the wound.
In addition to the standard symptoms of post-traumatic osteomyelitis (ICD 10 - M86), there are also hidden manifestations of the disease. They are detected using x-ray studies no earlier than one month after infection in the wound and the onset of the inflammatory process. These hidden symptoms of the disease include:
- the occurrence of vascular obliteration;
- replacement of muscle fiber with connective tissue;
- the appearance of changes in the periosteum;
- partial replacement of bone marrow with connective tissue.
How is post-traumatic bone osteomyelitis detected?
Diagnostics
When contacting a doctor, an initial examination of the patient is performed. At the initial stage of the disease, an accurate diagnosis can be made only on the basis of clinical symptoms, since radiological signs appear only after three to four weeks. To study the inflammatory processes, their degree of spread and intensity, the following diagnostic measures are prescribed to patients:
- Conducting local thermography.
- Thermal imaging.
- Perform a skeleton scan.
- Conducting computed tomography.
- Performing fistulography and radiographs.
Using X-rays, sequestration is detected along with foci of destruction, zones of osteosclerosis and osteoporosis, and, in addition, the deformation of the ends of bone fragments is determined. In the presence of a gunshot wound, metal fragments that get stuck in soft tissues are visible on the x-ray. Other diagnostic techniques make it possible to study in detail the affected area and identify the causes of the purulent process.
Disease treatment
Treatment for post-traumatic osteomyelitis of the jaws is carried out, as a rule, immediately. The doctor eliminates the inflammatory process and eliminates the foci of suppuration. At an early stage, doctors conduct conservative treatment using various medications. Patients, as a rule, take a course of taking antibiotics with a wide spectrum of effects. A puncture is done to remove the purulent congestion. In the presence of a mild form of the disease, such treatment is usually quite enough.
In the event that chronic post-traumatic osteomyelitis is accompanied by the formation of fistulas, ulcers or sequesters, an operation is performed. Unfortunately, one cannot do without surgical intervention in such a situation. In particular, surgery is required in the presence of severe intoxication, severe pain and with impaired limb function. Also, an operation is performed if conservative therapy does not bring a positive result.
Immediately before surgery, for ten to twelve days, patients undergo the necessary examinations, which give a complete picture of the disease. This makes it possible for doctors to choose the most effective methods of treating post-traumatic osteomyelitis, due to which it is possible to prevent certain complications.
During the operation, the surgeon removes dead areas of soft tissue along with necrotic parts of the bone. In addition, the doctor opens up purulent formations. Bone defects are corrected with different fixation structures. After osteosynthesis, the affected area is treated with hot saline, and, in addition, nitrofuran drugs and antibiotics.
Complications
Complications of post-traumatic osteomyelitis are divided into general and local. Local includes a pathological fracture in the affected area. It occurs under the influence of a force, which under normal conditions does not lead to deformation. The coalescence of fragments, along with the formation of corns, is significantly impaired. Pathological dislocations occur without a noticeable influence from the outside. These develop due to the destruction of the bone pineal gland or the spread of pus on the ligaments of the joint.
The false joint is a violation of the growth of bone fragments after a fracture. The process of ossification of fragments due to inflammation and pus is disturbed. They can combine with a specific loose tissue. Unlike bone calluses, it cannot provide tight fixation of fragments. Often there is an arrosive hemorrhage.
Ankylosis is another complication and is the loss of joint mobility due to fusion of the bone articular surface. In addition, contracture is often observed along with restriction of movement in the joint due to damage to muscles, tendons, skin or ligaments above its surface. Affected bones, as a rule, are deformed, shortened and stop growing. As a result, the absolute loss of the ability of the damaged area of the body to move is very likely.
Pneumonia
The common complications and consequences of osteomyelitis include pneumonia. Infection can enter the lungs from distant foci with blood flow. In the event that the focus is close, the path of entry is contact. Microscopic organisms sometimes get through the bloodstream into the inner heart membrane, causing inflammation or bacterial endocarditis.
Metabolic toxic products with bacteria are formed against the background of purulent necrotic destruction in the affected area and usually circulate in the blood. They penetrate the kidney tissue, lingering in it, and at the same time they are very harmful. As a result, renal failure may occur. With the flow of blood, the infection can also spread to the liver tissue, damaging the structure of the organ, thereby significantly disrupting its function. Among the most serious manifestations of such a violation is ascites, along with edema, jaundice and impaired consciousness.
This will be confirmed by any medical history of chronic post-traumatic osteomyelitis.
Restoration and prevention
After surgery, patients undergo a course of rehabilitation procedures, for example, electrophoresis, UHF therapy and physiotherapy exercises are required. The use of antibiotics remains mandatory for three weeks. These drugs are administered intravenously and intraarterially. During rehabilitation, it is important to take vitamins, and, in addition, follow a diet that is aimed at strengthening the body, and at the same time, at increasing its protective function.
The effectiveness of therapy directly depends on many different factors, for example, the complexity of the disease, the patient’s age, the presence of concomitant injuries, and so on. In this regard, prevention is the best way to avoid another inflammation after an injury or relapse after treatment. Any injuries along with cuts and injuries should be treated with antibacterial medicines.
Immediately after receiving injuries, various foreign bodies should be removed from the wound. Timely contacting a doctor in the presence of complex injuries always prevents the appearance of a purulent process in soft tissue and prevents the spread of infection directly to the bone.