Osteomyelitis is a purulent infection that affects the bone marrow of bone tissue as well as the periosteum. Post-traumatic osteomyelitis (ICD-10 code M86) is considered a serious disease that occurs after a bone injury or after any surgical intervention. This disease can affect men and women at any age.
Description of the disease
Post-traumatic osteomyelitis occurs when open fractures appear. The cause of it is the 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, then the affected area becomes inflamed, and if the injury is comminuted, then the purulent process can spread through the tissues. Accompanying the disease is severe intoxication along with hectic fever, an increase in ESR, leukocytosis and anemia. The area of the wound may be swollen and very painful, from ita large amount of pus comes out.
Next, let's move on to considering the causes of such a disease as post-traumatic osteomyelitis.
Reasons and peculiarities
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, as a rule, enter the bone and cartilage tissue during a cut, fracture or injury. There are the following types of osteomyelitis: 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 treated properly. The most vulnerable areas of the human body are those in which the bones are practically not protected by soft tissues.
For example, post-traumatic osteomyelitis of the lower jaw is very common. In a fracture, inflammation usually occurs only in 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 be the result of infection of the wound against the background of the corresponding injury. Most often, the bone is affected due to significant injury, multiple injuries and displacement of bone fragments.
Postoperative osteomyelitis can occur when a wound becomes infected as part of a surgical procedure. Despite disinfection treatment, in the human bodypathogens that are resistant to drugs may remain. In addition, suppuration can occur after the introduction of spokes, and, in addition, as a result of the imposition of skeletal traction or compression and distraction devices. This is the so-called pin osteomyelitis, which is a type of disease (post-traumatic osteomyelitis of the leg, for example).
Contact osteomyelitis is a consequence of the spread of pathogens into soft tissues. Bacteria penetrate into the bone marrow canals from adjacent areas of infection. Such foci are ulcers on the body along with abscesses, phlegmon, dental pathologies and the like. This type of disease is often found in children.
At risk are those who lead an antisocial lifestyle, and in addition, people who are physically weak, as their weakened immune system is not able to fight bacteria that enter the human body.
Infections
The causes of post-traumatic osteomyelitis may be the transfer of one of the infections. For example, because of 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 he alth troubles. For example, due to impaired immunity, the presence of vascular atherosclerosis, and, in addition, due to the influence of the following factors:
- the patient has varicose and venous abnormalities;
- due to diabetes, due to functional hepatic or renal impairment;
- in the presence of malignant tumors, as well as due to the removal of the spleen.
Now let's figure out what symptoms accompany the onset of this pathology. Case histories of post-traumatic osteomyelitis are of interest to many.
Symptoms of this pathology
Post-traumatic osteomyelitis can be accompanied by certain symptoms. This disease most often occurs in a chronic format.
The main signs of chronic post-traumatic osteomyelitis are the following manifestations:
- appearance of redness and swelling of the affected area of the body;
- appearance of pain and purulent discharge on palpation;
- fistula formation and fever;
- significant deterioration in general condition and well-being;
- appearance of sleep disorders;
- appearance 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 ofsevere 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 may occur in the area of the fracture, and pus is abundantly released from the wound.
In addition to the standard symptoms of post-traumatic osteomyelitis (according to ICD 10 - M86), there are also hidden manifestations of the disease. They are detected using x-ray studies no earlier than one month after the infection enters the wound and the onset of the inflammatory process. These hidden symptoms of the disease include:
- occurrence of vascular obliteration;
- replacement of muscle fiber with connective tissue;
- appearance of changes in the periosteum;
- partial replacement of bone marrow with connective tissues.
How is post-traumatic osteomyelitis of the bone diagnosed?
Diagnostics
When contacting a doctor, an initial examination of the patient is carried out. At the initial stage of the disease, an accurate diagnosis can only be made on the basis of clinical symptoms, since radiological signs appear only after three to four weeks. To study inflammatory processes, the degree of their spread and intensity, the following diagnostic measures are prescribed for patients:
- Performing local thermography.
- Perform thermal imaging.
- Performing a skeletal scan.
- Computed tomography.
- Performing fistulography and X-ray.
With the help of X-ray, sequesters are detected along with foci of destruction, zones of osteosclerosis and osteoporosis, and, in addition, deformation of the ends of bone fragments is determined. In the presence of a gunshot wound, metal fragments are visible on the x-ray, which get stuck in the soft tissues. The rest of the diagnostic methods make it possible to study the affected area in detail and identify the causes of the purulent process.
Treatment of disease
Treatment for post-traumatic osteomyelitis of the jaws is usually carried out immediately. The doctor eliminates the inflammatory process and eliminates the focus of suppuration. At an early stage, doctors carry out conservative treatment using various medications. Patients are usually treated with broad-spectrum antibiotics. A puncture is made to remove the purulent accumulation. In the presence of a mild form of the disease, such treatment is usually sufficient.
In the event that chronic post-traumatic osteomyelitis is accompanied by the formation of fistulas, ulcers or sequesters, an operation is performed. Unfortunately, surgical intervention in such a situation is indispensable. In particular, surgery is required in the presence of severe intoxication, severe pain and dysfunction of the limbs. Also, the operation is performed if conservative therapy does not bring a positive result.
Immediately before surgery for ten to twelve days, patients undergo the necessarysurveys that give a complete picture of the disease. This allows physicians to choose the most effective methods of treating post-traumatic osteomyelitis, which makes it possible to prevent certain complications.
During the operation, the surgeon removes dead areas of soft tissues along with necrotic parts of the bone. In addition, the doctor opens purulent formations. Bone defects are corrected with various fixing structures. After osteosynthesis, the affected area is treated with hot saline, and, in addition, with nitrofuran preparations and antibiotics.
Complications
Complications of post-traumatic osteomyelitis are divided into general and local. Local refers to a pathological fracture in the affected area. It occurs under the influence of a force that under normal conditions does not lead to deformation. Fusion of fragments, along with the formation of calluses, is significantly disturbed. Pathological dislocations occur without noticeable external influence. These develop due to the destruction of the bone epiphysis or the spread of pus to the ligaments of the joint.
False joint is a violation of the fusion of bone fragments after a fracture. The process of ossification of fragments due to inflammation and pus is disturbed. They can unite with a specific loose tissue. Unlike bone calluses, it cannot provide a tight fixation of fragments. Arrosive hemorrhage often occurs.
Ankylosis is another complication and is the loss of joint mobility due to fusion of the bone articular surface. Besidescontracture is often observed along with restriction of movement in the joint due to damage to the muscles, tendons, skin or ligaments above its surface. Affected bones tend to deform, shorten, 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
Pneumonia is one of the common complications and consequences of osteomyelitis. Infection can enter the lungs from distant foci through the blood stream. In the event that the focus is close, then the path of entry is contact. Microscopic organisms sometimes enter the inner lining of the heart through the bloodstream, causing inflammation or bacterial endocarditis.
Exchange 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 tissue of the kidneys, lingering in it, and at the same time very seriously harm. As a result, kidney failure may occur. With the blood flow, the infection can also spread to the liver tissues, damaging the structure of the organ, thereby significantly impairing its function. Among the most serious manifestations of such a violation is ascites, along with edema, jaundice and impaired consciousness.
Any history of chronic post-traumatic osteomyelitis will confirm this.
Recovery and prevention
After the operation, patients undergo a course of rehabilitationprocedures, for example, electrophoresis, UHF therapy and physiotherapy exercises are required. Within three weeks, the use of antibiotics remains mandatory. These drugs are administered intravenously and intra-arterially. 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 increasing its protective function.
The effectiveness of therapy directly depends on many different factors, for example, the complexity of the disease, the age of the patient, the presence of concomitant injuries, and so on. In this regard, prevention is the best way to avoid the next inflammation after injury or recurrence of the disease after treatment. Any injuries, along with cuts and injuries, should be properly treated with antibacterial medicines.
Immediately after injury, various foreign bodies should be removed from the wound. A timely visit to the doctor in the presence of complex injuries always prevents the appearance of a purulent process in the soft tissue and prevents the infection from spreading directly to the bone.
