Osteomyelitis of the calcaneal tuberosity (osteomyelitis of the calcaneal tuberosity)

general description

Osteomyelitis of the calcaneal tuber (calcaneal bone) is a purulent infectious inflammation of the heel bone, affecting all elements of the bone - bone marrow, the bone tissue itself and the covering tissue of the bone - the periosteum.
Unlike osteomyelitis of long bones (femur, tibia), which, as a rule, are initially initially acute, and after suffering acute osteomyelitis, chronic fistulous osteomyelitis develops, osteomyelitis of the calcaneal tubercle is extremely rarely acute with a violent clinical picture of acute purulent inflammation. Moreover, osteomyelitis of the calcaneal tubercle is a secondary disease that occurs against the background of purulent-inflammatory processes already existing in this area (diabetic ulcers, inflammation resulting from injuries to the heel area).

Osteomyelitis of any bone is always caused by the penetration of pathogenic microorganisms in various ways. It is extremely rare that osteomyelitis is not infectious in nature and bone inflammation occurs against the background of activation of the immune system.

The causes contributing to the occurrence of osteomyelitis of the calcaneus are:

• atherosclerosis of blood vessels of the lower extremities;
• chronic alcohol intoxication;
• diabetes;
• immunodeficiency;
• injuries to the heel area.

Surgical treatment of osteomyelitis

Treatment of osteomyelitis

Osteomyelitis (from ancient Greek ὀστέον - “bone”; μυελός - “brain”; -ῖτις - “inflammation”) is a purulent-necrotic process developing in the bone and bone marrow, as well as in the surrounding soft tissues, caused by pathogenic (pus-producing) bacteria or mycobacteria.

The most dangerous is osteomyelitis, which is caused by an internal infection. The disease develops in only 2 days. During these days, the symptoms of the disease are hardly noticeable. There may be general malaise, muscle pain, joint discomfort, and the person may not even suspect that he is developing osteomyelitis. Then the body temperature rises to forty degrees. Severe pain occurs in the area of ​​the affected bone. When moving, the pain intensifies, movement becomes limited. The disease further develops quickly. Very often this whole process is accompanied by a sharp deterioration, nausea and vomiting.

The main danger of asymptomatic osteomyelitis is the lack of treatment and the possible transition of the disease from a local form to a generalized one, from an acute stage to a chronic one. Therefore, any unusual sensations, increases in body temperature without other accompanying symptoms require diagnosis and investigation.

With osteomyelitis with a toxic form of the disease, blood pressure drops, pain is felt in the heart, convulsions and loss of consciousness are possible. The face becomes pale, the eyes become sunken, the skin turns yellow, the lips turn blue. When a traumatic form of osteomyelitis appears, it is very important to immediately consult a doctor, otherwise the person may die.

Traumatic osteomyelitis is characterized by acute symptoms. A high temperature and severe pain in the area of ​​injury are possible, after which all these symptoms are replaced by chronic ones. The person feels more or less normal, various purulent discharges are removed through the fistulous tracts that arise in the wound area and are the first cause of traumatic osteomyelitis. A severe form of osteomyelitis can result in blood poisoning.

According to clinical manifestations, osteomyelitis is divided into two types:

• local;
• generalized.

Causes of osteomyelitis

• The main causative agents of acute osteomyelitis are staphylococci, but other bacteria, rickettsia and some fungi are also possible, entering the bone tissue and provoking the onset of the disease.
• The main “fault” lies with Staphylococcus aureus, but the disease can also be caused by some Escherichia coli, hemolytic streptococcus and Pseudomonas aeruginosa. The disease can be caused by either a single pathogen or a group of pathogenic microorganisms.

We use modern methods in the surgical treatment of affected areas of bone tissue, the method of controlled transosseous osteosynthesis according to Ilizarov, osteosynthesis with external fixation rod devices. Treatment is carried out taking into account the pathogenicity of the pathogen, the reactivity of the body, the patient’s age, localization, prevalence and duration of the process, and the presence of complications.

Treatment goals:

1. Stop the purulent-inflammatory process (sanitation of the purulent focus (opening and drainage of purulent cavities), removal of sequesters - areas of non-viable bone tissue); 2. Reconstruction of the affected segment (necessary due to the formation of skin and bone tissue defects).

Indications for radical surgery for chronic osteomyelitis

• Sequestration, osteomyelitic bone cavity, fistula, ulcer;
• Repeated relapses of the disease with pain and dysfunction of the musculoskeletal system;
• Pathological changes in parenchymal organs caused by chronic purulent intoxication, etc.

Contraindications to radical surgical treatment of chronic osteomyelitis

• Decompensation of kidney function
• Decompensation of the cardiovascular and respiratory systems.

Course of inpatient treatment: 10-30 days.

Postoperative rehabilitation period: 6-12 months.

To treat this disease, you need to make an appointment with specialists at 45-88-00:

Kibataev Aibek Kasymkhanovich

Danshin Dmitry Pavlovich

Safarov Artur Mirshatovich

Symptoms of calcaneal tuber osteomyelitis

In the most common primary chronic form of calcaneal tuber osteomyelitis, the disease progresses slowly. In the area of ​​the heel tubercle, a skin ulcer appears, which grows and deepens over time.

At the bottom of the ulcer, the heel bone itself becomes visible, which, due to long-term inflammation, begins to collapse, and bone sequesters recede through the resulting ulcer.

The patient is bothered by pain in the area of ​​the calcaneal tubercle, although it should be noted that in the presence of concomitant diabetes mellitus or peripheral nerve disease, the pain may be insignificant. But regardless of the pain syndrome, a characteristic sign of the disease is the loss of the supporting function of the lower limb - the patient begins to limp and use auxiliary support devices.

Osteomyelitis is a disease characterized by the development of a purulent-inflammatory process in the bone caused by pathogenic microorganisms.

The main routes of infection into bone tissue are:

• hematogenous (with blood flow). Pathogenic microorganisms from any source of infection (for example, from carious teeth, inflamed tonsils) penetrate into the bone tissue through the bloodstream, leading to the development of osteomyelitis. In hematogenous osteomyelitis, the inflammatory process begins with the inner layers of the bone - the bone marrow and spongy bone are primarily affected. This type of osteomyelitis often occurs in childhood. This is due to increased blood supply to growing bones in children.
• direct infection of bone tissue. Direct infection of bone tissue can occur with open fractures, extensive, deep wounds. In some cases, pathogenic bacteria can penetrate this route during various orthopedic interventions.
• infection from nearby purulent foci (contact route). Pathogenic bacteria penetrate bone tissue from long-existing purulent-inflammatory foci in the surrounding soft tissues. An example is the development of osteomyelitis during felon (purulent inflammation of tissue on the finger).

The progression of the purulent-inflammatory process leads to the destruction of bone tissue. Its blood supply is disrupted, which further enhances necrotic processes in the bone. The transition of the inflammatory process to nearby tissues can lead to the formation of abscesses (circumscribed accumulations of pus), drainage of purulent contents to the outside, the development of arthritis (inflammation of the joints), and other complications.

Treatment of osteomyelitis requires the use of massive doses of antibacterial drugs. Surgical treatment is aimed at removing areas of dead bone tissue, purulent contents, and draining the inflammatory focus.

English synonyms

Osteomyelitis.

Symptoms

The main symptoms of osteomyelitis include:

• increase in body temperature
• severe pain in the area of ​​the affected bone
• redness, swelling, increased temperature of the skin in the area of ​​the purulent-inflammatory process in the bone
• decreased range of motion in joints adjacent to the area of ​​inflammation
• formation of fistulas (channels connecting the purulent focus with the external environment) with purulent discharge

General information about the disease

Osteomyelitis is a purulent-inflammatory process in bone tissue caused by pyogenic microorganisms.

In children, the most common cause of osteomyelitis is the spread of infection through the hematogenous route (through the bloodstream) from some source of inflammation (for example, in the presence of boils, purulent tonsillitis).

A special feature of bone tissue in children is its abundant blood supply. In most cases, osteomyelitis develops in the growth areas of the bones (metaphyses). In this case, the long bones of the limbs are most often affected. Pathogenic microorganisms are carried through the bloodstream into these parts of the bone, which leads to the development of osteomyelitis.

With hematogenous osteomyelitis, the purulent-inflammatory process begins from the internal parts of the bone. In this case, the bone marrow is affected, then the spongy bone. Subsequently, the process moves to the compact substance (the outer dense layer of bone) and the periosteum.

Due to the peculiarity of the localization of the osteomyelitic process, children may subsequently experience a slowdown in bone development due to damage to the growth zones by the inflammatory process.

In adults, hematogenous osteomyelitis is observed in 20% of cases. However, this disease is more common in men.

With increasing age, the incidence of vertebral osteomyelitis in adults increases. The infection can penetrate the spine hematogenously from inflammatory foci in soft tissues, lungs, genitourinary tract, and carious teeth. Two adjacent vertebrae with an intervertebral disc are affected.

With this form of osteomyelitis, pain occurs in the area of ​​the purulent-inflammatory process. The duration of the disease development can be up to 3 months. Destruction of the vertebrae and compression of the spinal cord can lead to motor and sensory disorders in these patients.

Osteomyelitis, which develops as a result of direct infection or spread of infection from nearby lesions into bone tissue, occurs more often in adults. Processes in which the immune status of the body decreases and the blood supply to bone tissue is disrupted predispose to the development of this disease. These include:

• Diabetes mellitus is a disease in which there is an increase in blood sugar levels. In this case, various types of metabolism are disrupted. People with diabetes often develop various purulent-inflammatory processes. This is aggravated by the fact that as a result of disorders of the nerve fibers (polyneuropathy), sensitivity is impaired. This leads to the fact that various wounds often go unnoticed by the patient, and inflammation quickly develops in them.

• Sickle cell anemia is a hereditary disease characterized by the formation of abnormal hemoglobin protein in red blood cells. This causes a decrease in the life expectancy of such red blood cells and their increased destruction. In this case, hypoxia develops (a decrease in the amount of oxygen supplied to the tissues) and thrombosis of various vessels.

As a result of the formation of blood clots in the vessels of the bones, the blood supply to this area of ​​\u200b\u200bbone tissue is disrupted and it dies. The addition of infection can lead to the development of osteomyelitis.

• Human immunodeficiency virus (HIV) – with this disease, the cells of the immune system are destroyed, which makes the body vulnerable to various infections.

• long-term use of glucocorticoids. Glucocorticoids are hormones of the adrenal cortex. Long-term use of this group of drugs for various diseases reduces the body's immune status.

Acute osteomyelitis can become chronic. Complicating the treatment of this form of the disease is the disruption of the blood supply to the bone, which is observed during the course of the purulent-necrotic process. This makes it difficult for antibacterial drugs to penetrate and reduces the effectiveness of the local immune response in bone tissue. In such cases, the radical treatment method is wide resection (removal of the affected bone tissue); in some cases, amputation may be required.

Who is at risk?

Risk groups include:

• persons with severe bone tissue injuries, deep wounds
• persons who have undergone orthopedic surgery
• persons suffering from diabetes mellitus
• persons with foci of infection in various organs and tissues (for example, long-term non-healing ulcers on the skin)
• patients whose vital functions require special medical devices (for example, various catheters) - these medical devices facilitate the penetration of pathogenic microorganisms from the external environment into the human body
• injection drug addicts.

Diagnostics

Diagnosis of osteomyelitis is based on identifying the symptoms of the disease, performing radiography, computed tomography and magnetic resonance imaging to detect purulent-inflammatory foci and characteristic changes in bone tissue.

For further treatment, it is of great importance to conduct laboratory tests of purulent discharge, bone biopsy materials from the source of inflammation to identify the type of infectious agent and its sensitivity to antibacterial drugs. This makes it possible to select the most effective antibiotics against a given pathogenic microorganism.

Laboratory research:

• General blood analysis. This analysis allows you to determine the number of red blood cells, hemoglobin, leukocytes, and platelets in the blood. With osteomyelitis, as a result of a pronounced inflammatory process in the bone tissue, an increase in the level of leukocytes will be noted.
• Erythrocyte sedimentation rate (ESR). A nonspecific indicator of the occurrence of various pathological processes in the body, mainly of an inflammatory nature. ESR is one of the indicators that allows you to assess the activity of the inflammatory process and its dynamics. With osteomyelitis, the ESR will be increased.
• Leukocyte formula. The leukocyte formula is the percentage of different types of leukocytes, which can change as a result of pathological processes in the body. With osteomyelitis, a shift in the leukocyte count to the left may be observed, which indicates the presence of a pronounced purulent-necrotic process in the bone tissue.
• Culture of flora with determination of sensitivity to antibiotics (purulent discharge, aspiration material (carried out using a special needle and syringe) and open bone biopsy).

The resulting samples are placed on special nutrient media that promote the growth of pathogenic microorganisms. This allows you to determine the exact type of infectious agent. Then antibiotics are selected that most effectively suppress these pathogens.

• Blood culture for sterility with determination of sensitivity to antibiotics. The principle of the method is similar to the previous study. Normally, human blood is sterile. In osteomyelitis, the causative agent of infection is found less frequently in the blood than in material obtained from the area of ​​bone tissue damage.

Research:

• Radiography. X-ray of the bone allows you to identify areas of bone destruction in the area of ​​the purulent-necrotic process. The disadvantage of the method is its low information content in the early stages of the disease, since it takes several weeks for the formation of pathological changes visible on radiography for osteomyelitis.
• Computed tomography (CT), magnetic resonance imaging (MRI). Computed tomography is based on the ability of X-ray radiation to penetrate tissues of varying densities. The principle of magnetic resonance imaging is the action of a strong magnetic field on the tissues and organs being studied.

Both studies use computer processing of the received information, resulting in the formation of layer-by-layer, highly informative images of the internal structures of the body. Computed tomography and magnetic resonance imaging can detect changes in the bone and surrounding tissues in osteomyelitis.

Treatment

Treatment of osteomyelitis requires the use of conservative and surgical methods. Conservative therapy consists of using antibiotics that are most effective against pathogenic microorganisms that cause a purulent-inflammatory process in bone tissue.

Surgical treatment consists of evacuation of purulent contents, removal of areas of necrotic (dead) bone tissue, and drainage of the purulent-inflammatory focus.

Prevention

There is no specific prevention of osteomyelitis. Persons with an increased risk of developing purulent-inflammatory diseases (for example, patients suffering from diabetes mellitus) should pay special attention to even minor damage to the skin - treat them thoroughly with antiseptics, use sterile dressings.

Recommended tests

• General blood analysis
• Erythrocyte sedimentation rate (ESR)
• Leukocyte formula
• Culture of flora with determination of sensitivity to antibiotics

Blood culture for sterility with determination of sensitivity to antibiotics

Incidence (per 100,000 people)

3. Symptoms and treatment of the disease

Symptoms of osteomyelitis

Acute osteomyelitis develops quickly, within 7-10 days. Symptoms of acute and chronic osteomyelitis are very similar and include:

• High temperature, irritability, fatigue;
• Nausea;
• Tenderness and swelling around the affected bone;
• Decreased range of motion.
• Vertebral osteomyelitis often causes severe back pain, especially at night.

Treatment of osteomyelitis

Diagnosis of osteomyelitis

is the first step towards treating this disease.
And this is a very difficult process. X-rays, blood tests, and bone scans
may be used to diagnose osteomyelitis .
In addition, the doctor must determine the type of microorganism (usually a bacterium) that caused the infection
. This is necessary in order to choose the right medicine. Most cases of osteomyelitis are treated with antibiotics, surgery, or both.

Antibiotics

help control infection and often avoid surgery. For patients with osteomyelitis, antibiotics are usually given through an IV for several weeks, followed by a course of antibiotic tablets.

In cases of severe or chronic osteomyelitis, surgery may be required to remove the affected tissue and bone

. Surgery in this case will help prevent further spread of the infection.

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