Download - Osteomylitis Ortho.report
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Reported by:
Sr. Jinggle U. Emata
John Erick S Enero
Calamba Doctors College
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I-DEFINITION
Osteomyelitis is an infection
of the bone.
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TYPES:
Acute osteomyelitis - the infection develops within twoweeks of an injury, initial infection, or the start of an
underlying disease.
Sub-acute osteomyelitis - the infection develops within one
or two months of an injury, initial infection, or the start of anunderlying disease.
Chronic osteomyelitis - the bone infection starts at least
two months after an injury, initial infection, or the start of an
underlying disease.
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II-CAUSES
caused by staphylococcus bacteria
Germs can enter a bone in a variety of ways, including:
Via the bloodstream
From a nearby infection
Direct contamination
A bone fracture, some injury, or a complication of orthopedic
surgery may result in a bone infection.
The bone infection may be caused by a pre-existing condition,
such as diabetes.
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Bone infections are divided into several types, including:
Hematogenous osteomyelitis - the infection travels through the bloodstream.
Post-traumatic osteomyelitis - these are bone infections that occur after trauma, such
as a compound fracture (broken bone that breaks the skin), or an open wound to
surrounding skin and muscle.
Vascular deficiency - people with poor blood circulation may develop an infection from
a seemingly minor scrape or cut, usually on the feet.
Vertebral osteomyelitis - this is osteomyelitis that occurs in the spine. It usually starts
with an infection in the bloodstream, but can also be the result of surgery or trauma
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III-SIGNS AND SYMPTOMS
Fever or chills
Irritability or lethargy in young children
Pain in the long bone
Local Swelling, warmth and redness overthe areaof the infectionNausea
Malaise
Tenderness and swelling around theaffected boneLost range of motion
Drainage of pus in the skin
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IV-DIAGNOSTIC TEST
Blood tests-reveal elevated levels of white blood cells and other factors thatmay indicate that your body is fighting an infectionImaging tests
X-rays can reveal damage to your bone.Computerized tomography (CT) scan. combines X-ray images taken from
many different angles, creating detailed cross-sectional views of a person's
internal structures.
Magnetic resonance imaging (MRI). Using radio waves and a strong
magnetic field, MRIs can produce exceptionally detailed images of bones and the
soft tissues that surround them.Bone biopsy is the gold standard for diagnosing osteomyelitis, because it can
also reveal what particular type of germ has infected your bone.
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V- MEDICAL
MANAGEMENT
Hyperbaric oxygen therapy- uses
a special chamber, sometimes
called a pressure chamber, to
increase the amount of oxygen inthe blood.
Amputation
Implantation of antibiotic beads
I & D
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VI-SURGICAL
MAGEMENT
Sequestrectomyremoval of
Sequestra.Saucerization- to promote
drainage
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VII-NURSING
MANAGEMENT
Focus care on controlling infection, protecting the bone from injury, and
providing support.Encourage the patient to verbalize his concerns about his disorder.
Encourage the patient to perform as much self-care as his conditionsallows.Help the patient identify care techniques and activities that promote rest
and relaxation and encourage him to perform them.Use strict aseptic technique when changing dressings and irrigating
wounds.Provide a well-balanced diet to promote healing.
Support the affected limb with firm pillows
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Provide thorough skin care.
Provide complete cast care.
Administer prescribed analgesics for pain.
Assess vital signs, observe wound appearance, and note any mewpain which may indicate secondary infection.Watch for signs of pressure ulcer formation.
Look for sudden malpositioning of the affected limb, which may
indicate fracture.
Explain all the test and treatment procedures.
Cont
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VIII-PROGNOSIS
Foracute osteomyelitis is very good
Forchronic osteomyelitis, which is more prevalent in
adults, the prognosis is still poor.
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I-DEFINITION
A medical condition in which
the bones become brittle andfragile from loss of tissue,
typically as a result of
hormonal changes.
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There are two main types of osteoporosis: primary and secondary.
Primary osteoporosis- occurs most commonly in women after menopause.
Osteoporosis affects twice as many females over the age of 70 years as males in the
same age group.
Secondary osteoporosis- can affect young and middle-aged people as well. It may
be caused by:
medications such as corticosteroids (e.g., prednisone*)chronic illnesses such as anorexia nervosa (an eating disorder that leads to
malnutrition)
Too much exercise - women who exercise excessively may lose their menstrual cycle
and the normal production of estrogen by the ovaries may stop
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II-CAUSES
PRIMARY OSTEOPOROSIS:Mild but prolonged negative
calcium balance
Inadequate dietary intake ofcalciumDeclining gonadal or adrenal
function
Faulty protein metabolism due to
estrogen deficiencySedentary lifestyle
SECONDARY OSTEOPOROSIS:Prolonged therapy with steroids or
heparinCigarette smoking
Total immobilization or disuse of
bone
Alcoholism, Malnutrition,
Malabsorption, Celiac disease,scurvy, lactose intolerance.Osteogenesis imperfect, sudecks
atrophy
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III-SIGNS AND
SYMPTOMS
Vertebral collapse
Causing a backache with pain that
radiates around the thrunkIncreasing deformity
Kyphosis
Spontaneous wedge fractures
Pathologic fractures of the neck or
femurLoss of height
Bones weaken
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IV-DIAGNOSTIC TEST
Bone mineral density testing- measures
the mineralization of the bone.Spine computed tomography-shows
demineralization.X-rays- show fracture or vertebral collapse
in severe cases.
Urine calcium- can provide evidence bone
turnover but is limited in value
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V- MEDICAL
MANAGEMENT
Medications:
BiphosphonatesAlendronate
Risedronate
Adequate calcium and vitamin
D intakeRaloxifene and calcitonin
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VI-SURGICAL MAGEMENT
Osteoporosis Surgery:
Vertebroplasty-is a minimally invasive procedure used to reinforce vertebrae with
compression fractures, which are common in patients with osteoporosis.Vertebroplasty
involves injecting an acrylic compound into the collapsed vertebra to stabilize the weakened
bone. The procedure is performed in an operating room or radiology suite and treatment of
each affected vertebra takes
approximately 1 hour.
Kyphoplasty-Multiple spinal compression fractures caused by osteoporosis may lead toheight loss, kyphosis (extreme curvature of the spine), and pain. Kyphoplasty, also called
balloon kyphoplasty, is a minimally invasive procedure that is used to restore the height ofthe vertebrae and stabilize weakened bone.
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VII-NURSING
MANAGEMENT
Focus on careful positioning, ambulation, and prescribed exercises.
Administer analgesics and heat to relieve pain as ordered.
Include the patient and his family in all phases of care.
Encourage the patient to perform as much self-care as her immobility
and pain allow.Provide the patient activities that involve mild exercise.
Check the patients skin daily for redness, warmth, and new
painsites.
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ContMonitor the patients pain level, and assess her response to
analgesics, heat therapy, and diversional activities.
Explain all treatments, tests, and procedure to the patient.
Make sure the patient and her family clearly understand the prescribed
drug regiman.Tell the patient to report any new pain sites immediately, especially
after trauma.Provide emotional support and reassurance to help the patient cope
with limited mobility.
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VIII-PROGNOSIS
The outlook for people with osteoporosis
is good, especially if the problem is
detected and treated early
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I-DEFINITION
TB of the spine with destruction of vertebrae resulting in curvature of
the spine.
Partial destruction of the vertebral bones, usually caused by a
tuberculous infection and often producing curvature of the spine.An old term fortuberculosisof thespine that caused softening and
collapse of thevertebrae, often resulting inkyphosis a "hunchback"deformity, which was called "Pott's curvature."
also known as Potts caries, David'sdisease,
andPott'scurvature,
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II-CAUSES
caused by
mycobacteriumtuberculosis.Partial destruction of the
vertebral bones, usuallycaused
by a tuberculous infectionand
often producing curvature of thespine.
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III- SIGNS AND
SYMPTOMS
back pain
fever
night sweating
anorexia
Spinal mass, sometimes
associated with numbness,paraesthesia, or muscle
weakness of the legs
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IV-DIAGNOSTIC
TEST
Blood tests
- CBC: leukocytisis elevatederythrocyte sedimentation rate>100 mm/h
The Mantoux Test (Tuberculin Skin Test)
Injection of a purified protein derivative (PPD). Results are positive in 84-95% ofpatients with Potts disease who are not infected with HIV.
Erythrocyte Sedimentation Rate (ESR)
ESR may be markedly elevated (>100 mm/h)
Microbiology studies- are used to confirm diagnosis. Bone tissue or abscess
samples are obtained to stain for acid-fast bacilli (AFB), and organisms are isolated for
culture and susceptibility.Radiography- Radiographic changes associated with Potts disease present relatively
late.
CT scanning provides much better bony detail of irregular lytic lesions, sclerosis, disk
collapse, and disruption of bone circumference.
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V-MEDICAL
MANAGEMENT
Anti-Tuberculosis Chemotherapy
Surgical Drainage of Abscess
Surgical Spinal Cord
DecompressionSurgical Spinal Fusion
Spinal Immobilization
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MEDICATIONS:
Isoniazid (Laniazid, Nydrazid)
Rifampin (Rifadin, Rimactane)
Pyrazinamide
Ethambutol (Myambutol).
Streptomycin
Cont
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VI-SURGICAL
MANAGEMENT
Richards intramedullary hip screw -
facilitating for bone healingKuntcher Nail - intramedullary rod
Austin Moore - intrameduallary rod (for
Hemiarthroplasty) Surgery includes ADSF (
Anterior Decompression Spinal Fusion).
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VII-NURSING
MANAGEMENT
Investigate report of pain, noting characteristics, location, intensity (0-10
scale).Provide firm mattress and small pillows.
Suggest patient assume position of proper comfort while in bed or chair.Promote bed rest as indicated.
Encourage frequent changes of position.
Apply warm or moist compression the affected area severalties a day
Provide gentle massage
Encourage use of stress management techniques.Administer no steroidal anti-inflammatory drugs as prescribed.
Administer anti-biotic as prescribed
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VII-PROGNOSIS
The progress is slow and lasts for months or even years.
Prognosis is better if caught early and modern regimes of
chemotherapy are more effective.
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REFERENCES:
Professional guide to disease 9th edition Lippincott Williams and Wilkins
http://www.medicinenet.com/osteomyelitis/article.htm
http://www.fpnotebook.com/ortho/ID/OstmyltsMngmnt.htmfaculty.uoh.edu.sa/b.hijah/documents/Osteomyelitis.ppt
medical-dictionary.thefreedictionary.com/osteoporosis
www.spine-health.com ConditionsOsteoporosis
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