Osteitis is an acute or chronic inflammation of the bone tissue. It affects long tubular bones more often, occurs less often in short tubular bones and vertebrae. It can be acute or chronic. Acute osteitis is manifested by intense tearing, jerking pains, edema, hyperemia, general intoxication. With chronic osteitis, the condition is satisfactory, the pain syndrome is expressed slightly, there is a fistula. The diagnosis is made on the basis of complaints, examination data, X-ray results, fistulography and other studies. Treatment – surgical interventions, antibiotic therapy.
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Osteitis refers to common pathological conditions, but it almost does not occur in isolation, since bone inflammation rarely occurs without the involvement of neighboring structures. In combination with inflammation of the periosteum is called osteoperiostitis, in combination with inflammation of the bone marrow – osteomyelitis. Hematogenous osteitis usually affects children. Other nonspecific forms of the disease can be detected in people of any age.
The direct cause of bone inflammation is the pathogenic flora. In 80-85% of cases, nonspecific osteitis is caused by staphylococci, in other cases pneumococci, streptococci, Pseudomonas aeruginosa, E. coli, Klebsiella, vulgar proteus are sown from the focus. The disease can develop with some specific infections. The main etiological factors of osteitis:
- Hematogenic spread of infection. Typical for children. The gates for the penetration of pathogens are the tonsils, mucous membranes of the oral cavity, upper respiratory tract, wounds and abrasions.
- Contact bone lesion. It occurs with open fractures (including gunshot fractures), after surgical interventions on bones (usually osteosynthesis). It is a consequence of infection of the wound. Sometimes the bone is affected as a result of the transition of purulent inflammation from the surrounding tissues (for example, with phlegmon).
- Specific infections. Pathogens enter the bone from the primary focus. The most common variants of specific osteitis are tuberculosis of bones and joints, bone damage in tertiary syphilis. Less often, osteitis is diagnosed with leprosy and brucellosis.
A significant role in the development of the infectious process is played by the general condition and the level of resistance of the body. Hematogenous osteitis manifests in 40-50% of cases against the background of acute viral infection. The posttraumatic form of the disease occurs more often with combined trauma, concomitant chronic somatic pathology.
Osteitis is characterized by the processes of destruction and proliferation of bone tissue. In acute processes, the destruction of bone substance prevails. As a result of the vital activity of pathogenic microorganisms, bone tissue resolves, cavities with purulent and necrotic contents form in the bone. In chronic inflammation, the granulation tissue filling the cavities is predominantly proliferative.
The simplified classification implies the division of osteitis into acute and chronic, hematogenic and non-hematogenic. There is an extended systematization of the alphabet, compiled taking into account the following factors:
- Time of occurrence: primary (the focus is formed in the bone) and secondary (inflammation passes to the bone from neighboring structures).
- The path of penetration: endogenous (hematogenic spread), exogenous (posttraumatic), contact (from neighboring purulent foci), iatrogenic (postoperative).
- Type of microorganisms: purulent flora (staphylococci, pneumococci, etc.), anaerobes (clostridia, non-clostridial flora), pathogens of specific infections (Koch’s sticks, pale spirochete, etc.).
- Course: acute, subacute, primary chronic, chronic.
- The number of foci: mono- and polypocal, polylocal.
- Appearance: without a fistula, with a fistula, with a soft tissue defect, etc.
The symptoms are determined by the form of the disease. The onset of hematogenous osteitis is acute. The patient’s body temperature suddenly rises to 39-40 °C. There are weakness, weakness, chills, nausea, tachycardia. Rapidly increasing pain occurs in the affected segment. Pain sensations become twitching, drilling, bursting. The pain syndrome is so intense that the patient avoids any movements.
The affected segment is edematous, the skin is hyperemic. There is a sharp soreness with palpation and axial load, restriction of movements. There are three variants of the course of hematogenous osteitis: with a predominance of local symptoms, in expanded (septicopiemic) and toxic forms. In the latter case, the disease develops so rapidly and rapidly that patients often die even before the pain syndrome appears.
Posttraumatic and postoperative osteitis are formed some time after injury or surgery. The edges of the wound turn red, soft tissues swell, purulent discharge appears. The general condition of the patient worsens, hyperthermia, weakness, general intoxication phenomena, increasing anemia are noted. The course is severe, but the clinical manifestations are usually not as pronounced as in the hematogenic variant of the disease.
Posttraumatic osteitis is prone to a chronic course. A few weeks after the manifestation of these symptoms, a fistula is formed, from which pus is released. The general symptoms subside, the condition normalizes, but the fistula with a foul-smelling discharge can persist for many years. The primary chronic course is characteristic of specific osteitis, which differ significantly in their manifestations depending on the type of pathogen.
Acute osteitis can be complicated by sepsis, which poses a threat to the patient’s life. With a chronic inflammatory process, contractures form, false joints form, and the likelihood of malignant tumors increases. With a prolonged course of osteitis, amyloidosis of the internal organs develops. Pathology negatively affects all aspects of the patient’s life: the ability to work is reduced or lost, because of the specific sharp smell of the discharge, socialization is difficult.
The disease is diagnosed by orthopedic traumatologists. The diagnosis is established on the basis of anamnesis, clinical picture and data from additional studies. The survey plan may include:
- Radiography. The main method of instrumental diagnostics. It is uninformative in the initial stages. Subsequently, it confirms the presence of a bone cavity, sequestration, sclerosis sites. During periods of exacerbations, it reveals signs of periostitis.
- CT, MRI. They are required for ambiguous radiography data due to the small size of foci and extensive zones of osteosclerosis. They can be carried out during the preparation for surgery.
- Fistulography. It is performed at the stage of preparation for surgery, allows you to clarify the direction and features of the location of the fistula, the volume of cavities and other data necessary for the complete removal of the purulent focus.
- Laboratory tests. In acute osteomyelitis, the presence of signs of inflammation is confirmed (increased ESR, leukocytosis with a shift to the left). In a chronic process, it is possible to verify the exacerbation, assess the condition of internal organs.
The treatment is complex, carried out in the conditions of the traumatology department, includes conservative measures and surgical interventions. The tactics of therapy is determined by the type of osteitis.
Treatment of acute osteitis
Upon admission, the affected segment is fixed with a plaster or plastic bandage. Patients are prescribed drug therapy aimed at fighting infection, eliminating intoxication, mitigating the severity of symptoms:
- Antibiotic therapy. Cephalosporins, semi-synthetic penicillins, lincomycin are used. The drugs are administered intravenously or intramuscularly.
- Detoxification measures. Intravenous infusions of plasma, crystalloid solutions and blood substitutes are carried out.
- Symptomatic therapy. To reduce the severity of the pain syndrome, painkillers are prescribed. In case of violations of the functions of organs and systems, appropriate medications are used.
After the formation of a purulent cavity, surgical interventions are performed. The bone is opened with a milling cutter, the cavity is washed, and flow-washing drainage is organized. In case of swelling in soft tissues, wide incisions are made, drains are installed.
Treatment of chronic osteitis
During the period of exacerbation, the treatment regimen is similar to that of acute osteitis. Antibiotic therapy and detoxification therapy are prescribed, purulent cavities and intermuscular phlegmons are opened. After the elimination of acute phenomena , the following interventions are carried out:
- Sequestrectomy. Granulations, areas of necrotic and sclerosed bone are completely excised. Washings and dressings are carried out until the wound is completely cleaned.
- Bone grafting. After cleansing the wound and eliminating inflammatory phenomena, the removed bone fragments are replaced with auto- or homotransplants.
- Operations for false joints. The modified ends of the bone are refreshed, a bone graft is installed, fixation is performed with devices for osteosynthesis.
- Elimination of deformations. Taking into account the peculiarities of deformation, osteotomy, bone resection and plastic surgery, correction using external fixation devices, limb elongation are performed.
In some cases, complex multi-stage interventions are required. In the postoperative period, long-term rehabilitation is carried out, aimed at increasing the volume of movements, restoring the function of the limb.
The prognosis for osteitis is always serious. In the acute period, there is a risk of life-threatening complications. Complete recovery is more often achieved with an acute process or a recent chronic osteitis. In chronic osteitis, the outcome is often less favorable due to bone restructuring, the formation of extensive soft tissue scars, the occurrence of trophic disorders and other factors.
Preventive measures include early treatment of open bone injuries with the removal of non-viable soft tissues and copious washing of the wound, careful observance of aseptic rules during bone operations. Timely treatment of infectious and inflammatory diseases that can cause the disease or increase the risk of developing osteitis plays an important role.