Lapis ISSN 2398-2969

Osteomyelitis

Synonym(s): Bacterial osteomyelitis, fungal osteomyelitis

Contributor(s): Alana Shrubsole-Cockwill, Joseph Harari

Introduction

  • Cause: (most common) bacterial infection secondary to dental disease   Dental malocclusion / overgrowth  , introduced during orthopedic surgery   Limb fracture repair: internal fixation   or contamination from wounds or chronic ulcerative pododermatitis   Ulcerative pododermatitis (Bumble foot)  .
  • Treatment:
    • Early antibiotics; culture and sensitivity   Therapeutics: antimicrobials  is essential because expensive antibiotics needed for a protracted time.
    • Stabilization of fractures   Limb fracture      Spinal injury   and excision of necrotic material/teeth/bone sequestrae.
    • Surgery; if chronic osteomyelitis.
    • Euthanasia   Euthanasia  in severe cases of ulcerative pododermatitis.
  • Diagnosis
    • Radiographic changes: these lag 10-14 days behind surgery or introduction of infection.
    • Clinical signs.
    • Discharging sinuses, swelling at surgery site, limb dysfunction.

Presenting signs

  • Acute: pyrexic systemic illness (very young animal following omphalophlebitis) - rare.
  • Chronic: limb dysfunction, muscle wasting, local pain, draining fistulous tracts.
  • Pain and lameness: sterile inflammatory reaction to implants, ulcerative pododermatitis.

Acute presentation

  • Systemically ill, lame (neonates).

Geographic incidence

  • Fungal osteomyelitis in warm climates (tropical and sub-tropical - rare in UK), eg coccidiomycosis, histoplasmosis, nocardiosis, cryptococcosis, aspergillosis, blastomycosis.

Age predisposition

  • Young: (acute osteomyelitis as primary disease following hematogenous spread) - rare.

Cost considerations

  • Long courses of antibiotics necessary.
  • Chronic osteomyelitis: surgery usually necessary to remove associated teeth, sequestrae, implants and graft bone.
  • Amputation may be necessary with severe ulcerative pododermatitis.

Special risks (eg anesthetic)

  • Chronic osteomyelitis is rare unless bacterial contamination, tissue damage and continuing fracture instability exist.
  • Sterility is of paramount importance throughout any procedure involving hard tissue since treatment is problematic due to enlodgement, persistence of infection in bone and implants.
  • Infection can cause    →   implant loosening    →     instability    →     reduction in body's ability to resolve the infection and decreased bone healing.
  • Operate on all bone graft sites with separate instruments and fresh surgical gloves.
  • Harvest graft before touching infected site.
  • Culture and sensitivity are essential; mixed infection common/anaerobic infection uncommon.
  • With dental associated abscesses   Abscess  , perform culture and sensitivity of the abscess capsule.

Culture surgically recovered tissue or implants. Superficial swabs from discharging sinuses are of little value.

Pathogenesis

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Diagnosis

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Treatment

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Prevention

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Further Reading

Publications

Refereed papers
  • Recent references fromPubMedandVetMedResource.
  • Lindsey M J (2000)Metaphyseal osteomyelitis. Vet Rec146(1), 28PubMed.
  • Dernell W (1999)Treatment of severe orthopedic infections. Vet Clin North Am Small Anim Prac29, 1261-1274PubMed.
  • Harcourt-Brown F M (1995)A review of clinical conditions in pet rabbits associated with their teeth. Vet Rec137(14), 341-346PubMed.

Other sources of information

  • Hess L, Tater K (2012).Dermatologocal diseases. Bacterial Infections. Ulcerative Pododermatitis.In: Ferrests, Rabbits & Rodents. Clinical Medicine and Surgery. Eds: Quesenberry K E & Carpernter J W. 3rd edn. Elsevier. pp 235. ISBN: 978-1-4160-6621-7.
  • Vella D (2013).Rabbits. Dental Disease.In: Clinical Veterinary Advisor. Birds and Exotic Pets. Eds: Mayer J & Donnelly T M. Elsevier. pp 355-360. ISBN: 978-1-4160-3969-3.
  • Vella D (2013).Rabbits. Pododermatitis.In: Clinical Veterinary Advisor. Birds and Exotic Pets.Eds: Mayer J & Donnelly T M. Elsevier. pp 407-409. ISBN: 978-1-4160-3969-3.
  • Capello V (2006)Small Mammal Orthopedics.In: Proc BSAVA Congress. pp 209-211.


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