Acute hematogenous osteomyelitis

Acute hematogenous osteomyelitis is one of the frequently occurring purulent-septic diseases of newborns. The spread of infection is hematogenous. Osteomyelitis may be the primary focus or one of septicopyemic lesions in children with sepsis. In the first case, the causative agent is the golden hemolytic staphylococcus, in the second, as a rule, the gram-negative microflora.

In newborns, as a rule, metaepiphysis of long tubular bones (hip, shoulder, lower leg, forearm) is affected. Small and especially flat bones are rarely affected. In some cases, the process begins with the synovial membrane of the joint and then proceeds like arthritis or osteoarthritis. This is due to the peculiarity of the blood supply to the bones and synovial membranes in children of the newborn period (autonomy of the blood supply to the epiphysis, the presence of a large number of small, branched vessels that go radially through the epiphyseal cartilage to the ossification nuclei, etc.).

The course of osteomyelitis depends on a number of factors: the localization of the process, the virulence of the microorganism, the background on which the disease developed, the state of the immunological properties of the organism.

The clinical course distinguishes between toxic, septic-piemic and local forms. The disease usually begins with acute fever, deterioration of the child. One of the first signs of osteomyelitis is the pseudoparesis of the affected limb - the child stops moving the handle or leg, keeps it in a forced position (the upper limb hangs along the trunk, the lower limb is bent in the hip and knee joints, withdrawn and slightly rotated outwards). The pronounced contracture, the smoothness of the contours of the joint are explained by the proximity of the lesion focus. Passive movements cause severe pain. In advanced cases, when there is a breakthrough of pus in the joint cavity, purulent arthritis develops, and with the break of subperiostal abscess-phlegmon of soft tissues.

A serious complication is the metastasis of infection in other bones, organs, the development of sepsis.

X-ray signs of osteomyelitis appear from the 10th to 12th day of the disease (thickening of soft tissues, enlargement of the joint gap, fuzziness of the epiphysis contours - "fimbriament", appearance of foci of destruction in bone metaphysis, periosteal reaction).

Treatment consists in immobilization of the affected limb (the arm is fixed with a Dezo bandage, with the lower extremity injured, a Shaked leukoplastic extension is applied), antibacterial, desensitizing and immunocorrecting therapy.

When arthritis is expressed, puncture of the joint is used, arthrotomy is rarely performed to avoid the development of joint stiffness. Soft tissue phlegmon is an indication for an autopsy.

When the process is localized in the proximal epiphysis of the femur after the removal of the traction for the prevention and treatment of abnormal dislocation of the hip, special tires are used to hold the hips in the breeding state. To prevent severe deformities of the limbs, all children who have suffered osteomyelitis should be observed at the orthopedic clinic for follow-up. Complications of metaepiphyseal osteomyelitis are manifested in the form of joint deformities, pathological dislocations, and limb growth disorders.