Chronic osteomyelitis: causes, symptoms, diagnosis, treatment

Osteomyelitis is an inflammatory disease of the bones and surrounding soft tissues, which arises as a result of their defeat by pyogenic bacteria. Let us consider the information about the disease in more detail. Particular attention will be paid to a form of the disease, such as chronic osteomyelitis. We learn about the causes of its appearance, the methods of diagnosis and treatment.

Osteomyelitis: classification of the disease

Based on various factors, there are several classifications of the disease. Depending on the conditions of the onset of the disease, it can be:

• Primary (hematogenous);
• Secondary (post traumatic);
• Odontogenic.

Hematogenous osteomyelitis occurs as a result of the introduction of microbes through the blood into the bone tissue from purulent wounds, pustules on the skin or inflammatory foci of internal organs. In most cases, this type of disease affects children. Hematogenous osteomyelitis begins suddenly and in the early days is accompanied by symptoms of intoxication: high fever, nausea, vomiting, general weakness, headaches. After a while (up to two days) there is edema of the affected limb, which is accompanied by severe pain.

Post-traumatic osteomyelitis can occur after an operation on the bones, an open fracture or a gunshot wound. This occurs with the presence of contributing factors, such as, for example, the absence or misconduct of surgical treatment, the presence of large hematomas or foreign bodies. They all contribute to the multiplication of bacteria, since they interfere with the normal healing process.

To a separate group it is customary to include odontogenic osteomyelitis. It is an inflammatory process in the maxillofacial area. Odontogenic osteomyelitis affects the tissues of the periodontal and tooth, therefore the disease is closely connected with dentistry. This type of ailment is accompanied by headaches, fever and general weakness of the body. When it progresses, there may be difficulty in swallowing, the appearance of bad breath from the mouth, swelling of the mucous membrane, plaque in the tongue.

The following forms of osteomyelitis, which we will consider, depend on the nature of its course:

• acute;
• chronic.

As a rule, treatment begins already at the first stage of the disease. But in the absence of adequate therapy, acute osteomyelitis becomes chronic.

Less common are such varieties of the disease:

• The Ollier syndrome;
• Brody's abscess;
• Garre's disease.

So, we got acquainted with the general information about osteomyelitis. It's time to consider in more detail its chronic form.

Causes of the disease

To find the causes of chronic osteomyelitis, it will not be necessary to conduct long searches. It was mentioned above that the disease occurs as a result of improper treatment of its acute form.

The causative agent of chronic osteomyelitis in most cases is Staphylococcus aureus. Although there are situations when the appearance of the disease can provoke Pseudomonas aeruginosa, fungus, proteus, E. coli.

So, the main causes of chronic osteomyelitis:

• Later detection of the causative agent of the disease;
• Improper treatment of acute disease;
• Untimely detection of the source of an infectious disease.

Symptoms of the disease

The way chronic osteomyelitis develops first of all depends on the nature of the course, location and prevalence of the inflammatory process. In most cases, the infection affects those tissues that are next to the affected.

For chronic osteomyelitis is typical:

• Blanching of the skin;
• Decreased appetite;
• Sleep disorders;
• The appearance of apathy and lethargy.

In addition, during the development of the disease often there are purulent fistula. When they are exposed to adjacent tissues, it is possible that abscesses, phlegmon, are formed.

If chronic osteomyelitis has hit the lower jaw, there may be an increase in lymph nodes.

In addition to all this, the disease is accompanied by a general deterioration of health, signs of intoxication and painful sensations in the area of the damaged part of the body: humerus or femur, vertebra and so on.

Diagnosis of the disease

To identify chronic osteomyelitis, you can contact a traumatologist, a surgeon, an orthopedist. Diagnostics will include a number of activities.

The patient can be assigned:

• Survey, inspection, feeling.
• Radiography. An X-ray can show structural changes in the bone a week after the onset of the disease.
• Biochemical and general blood analysis to determine the rate of erythrocyte sedimentation and the presence or absence of a pathogenic agent.
• Cytological and bacteriological examination of the wound, fistula and bone marrow.
• Ultrasound of the damaged area. It is necessary to detect fluid accumulation.
• Angiography. It is carried out with the purpose of detection of the bloodless areas.
• Magnetic resonance and computed tomography. It is conducted in order to obtain information on the extent, location, distribution and nature of pathological changes.
• Radionuclide studies are necessary for the timely detection of the disease, its severity and the nature of the inflammatory processes.

It is recommended not only to undergo an external examination and take an X-ray, but also to find the time for the maximum diagnosis, since only in this case it will be possible to choose the most optimal treatment option.

Differential diagnostics

Chronic osteomyelitis in its symptoms may be similar to some other diseases. That is why differential diagnostics is of great importance . It will help to establish the most accurate diagnosis and prescribe effective treatment.

The course of osteomyelitis may be similar to:

• The appearance of tumors on the bone;
• Tuberculosis of bone;
• Osteochondropathy;
• Fibrotic osteodysplasia.

Medication

Treatment of acute form of the disease involves the use of topical agents: sorbents, anti-inflammatory ointments, proteolytic enzymes, and antibiotics.

With traumatic lesions and generalized type of osteomyelitis, several types of therapy are necessary:

• Detoxification with infusion of saline, "Reopoliglyukin" and other substances;
• Antibacterial with the application of antibiotics of bone-trophic action or special preparations in case of detection of the type of pathogen;
• Immune with the introduction of specific sera of staphylococcal anatoxin, autovaccine.

Surgery

The need for surgical intervention arises in cases where there is a large number of sequestrants that do not resolve over time. This also includes cases of fistula formation or the presence of serious renal diseases in the patient.

In case of chronic osteomyelitis, surgical treatment includes several mandatory procedures:

• Removal of nonviable tissues;
• Wound treatment with antiseptic and antibiotic agents;
• Plastic of soft and bony tissues;
• Draining the wound;
• The installation of a catheter in the artery, which is located next to the lesion. This is necessary for the further introduction of antibiotics through it.

Physiotherapy

Osteomyelitis disease requires treatment and physical factors. Their main goal is to eliminate inflammation, activate recovery processes, accelerate the formation of sequesters, reduce the sensitivity of the body to bacteria, stimulate immunity.

To reduce the activity of the inflammatory process, the patient can be assigned:

• Infrared laser therapy;
• UHF therapy;
• Erythemic doses of SUF-irradiation;
• Microwave therapy.

The above procedures are performed only in combination with antibiotic therapy and in the presence of ways for outflow of fistula (pus).

To accelerate the processes of tissue repair is used:

• Ultrasound therapy;
• Electrophoresis of agents that improve the metabolism of vitamins and substances;
• Peloidotherapy;
• High-frequency magnetotherapy;
• Applications of paraffin and ozocerite.

During chronic osteomyelitis in the remission phase, calcium chloride electrophoresis is performed. For vasodilation in the affected area, the use of electrophoresis of vasodilators is possible.

In order to improve metabolic processes in connective tissue, it is necessary:

• Ultrasound therapy;
• Percutaneous electrostimulation;
• Radon and hydrogen sulphide baths;

In the stage of remission of chronic osteomyelitis, peloidotherapy and low-frequency therapy are used to reduce the activity of the coagulating blood system.

To activate the immune system, the patient is assigned:

• heliotherapy;
• Electrophoresis of drugs that affect immunomodulation;
• High-frequency magnetotherapy in the thymus region;
• Suberythmic doses of SUF-irradiation;
• Laser irradiation of blood.

To get rid of toxins, the patient needs three times a day to drink chloride-sodium bicarbonate mineral waters (Essentuki No. 4, Borjomi, and so on).

To improve the supply of oxygenated tissues to affected tissues, oxygenobarotherapy or ozone baths can be used.

Contraindications to physiotherapy

Despite the fact that treatment with physical factors brings a lot of benefits, there are several situations when it is strictly prohibited. Here you can refer cases of having a patient:

• High body temperature;
• Septicopyemia;
• Severe intoxication;
• Abscesses in the absence of an outflow of pus.

Consequences of the chronic form of the disease

Chronic osteomyelitis can cause a number of serious and life-threatening consequences. Ailment can lead to fibrous dysplasia, which, in turn, can provoke the appearance of tumors. Bone tissue becomes scarring and pus begins to spread beyond its limits. During this period, blood can be contaminated, which will lead to death.

Untimely treatment of the disease can provoke the appearance of hematogenous osteomyelitis. It is characterized by the appearance of large sequesters and an extensive purulent process. All this is accompanied by metastasis in internal organs.

In addition to everything, it is worth noting that osteomyelitis affects not only the bones, but also on other organs: liver, kidneys, endocrine system. Lack of timely treatment can lead to kidney failure and death of the patient.

Prevention of chronic osteomyelitis

We learned about a disease like osteomyelitis. Classification, symptoms and possible ways of treatment were considered in the article. It remains to recall another important issue. Are there ways that can help prevent an illness?

Prevention of chronic osteomyelitis is the timely treatment of its acute form. Even at the first signs of a possible disease you need to seek qualified help. After all, as is known, it is easier not to admit the appearance of a problem, than to struggle with it all my life.