The susceptibility in the sickle cell hemoglobinopathies to bacterial infections has increased. During the sickling, due to microscopic infarcts, the blood invasion of intestinal microorganisms is facilitated. Besides, there is also splenic dysfunction. The diaphysis of the long bones, flat bones, the small bones of the hands and feet are often held.
Acute vaso-occlusive crisis of the table is difficult to differentiate. It is difficult to distinguish the picture from an acute vaso-occlusive crisis. In both cases, there is fever, bone ache and leukocytosis. With MRI, one cannot distinguish an infection from an infarct. In a crisis attack, no response is obtained, needle aspiration and culture should be performed.
A long-term weeks antibiotics treatment may be necessary for healing [ 3 , 9 ]. Traumatic osteomyelitis develops as secondary in animal bites especially due to Pasteurella multocida , and when blood is taken from newborns heel with needle sticking, during bone marrow aspiration, puncture injuries especially when standing by Pseudomonas or by Pseudomonas through any injury somewhere and due to open fractures including osteomyelitis.
As Aeromonas is an unusual type of bacteria causing osteomyelitis with contaminated water [ 10 ]. Postoperative osteomyelitis may develop in the process that follows the reduction of closed fractures, craniotomies, median sternotomies and other bone surgeries [ 10 ].
Postoperative is mainly multifocal. Drug addiction may cause multifocal osteomyelitis. The scanning of multifocal hot spots on the bone may reveal multiple tumors, too [ 10 ].
This is observed in childhood and among young adults. Girls are more frequently affected. There are attacks that show similarity to osteomyelitis, recurrent high fever, swelling in bones, ache and radiologic visions.
Palmoplantar pustulosis, psoriasis, arthritis, sacroiliitis, and inflammatory intestinal disease may occur together with the Sweet's syndrome. Most frequently, the clavicle and the calcaneus are affected.
Bone cultures are sterile. Clear benefits of antibiotics cannot be shown, steroids and anti-inflammatory treatment is recommended. Although the etiology is unknown, the prognosis is positive [ 10 ]. Any organism a rare one or superficial fungi can cause osteomyelitis in these patients [ 10 ]. Side effects of the antibiotics treatment hematological, renal, hepatic [ 15 ]. Hyperthermia related to infections [ 16 , 17 ].
Fluid Volume Deficiency Risk with regard to excessive fluid loss [ 16 , 17 ]. Change in comfort depending on the infection, swelling, and hyperthermia process in the bone [ 15 ]. Pain and discomfort, Physical Restriction of Movement associated with musculoskeletal disorders [ 16 , 17 ].
Less Nutrition than the Body Requirements related to loss of appetite [ 15 ]. Risk of Deterioration in Skin Integrity in relation to physical immobilization [ 15 ]. Change in health condition, Anxiety in relation to hospitalization [ 16 , 17 ]. Risk of Injury in relation to immobilization because of spread of infections [ 16 , 17 ]. Limited physical activity, Social Isolation in relation to therapeutic isolation [ 16 , 17 ].
Risk of Colonic Constipation due to immobility [ 15 ]. Deficit in Entertainment Activities due to long-term hospitalization and insufficient mobility [ 15 ]. Poor Nutrition: Change in Nutrition due to anorexia that is secondary to the infection process [ 15 ]. The situation is Risk of Ineffective Management of Therapeutical Regime due to the lack of knowledge on wound care, activity limitations, symptoms and findings of complications, follow-up of pharmacological treatment and care check-up [ 15 ].
The nursing of children who suffer from heavy musculoskeletal infections; for a wide range of evaluation it requires a multidisciplinary team approach that consists of as well as the hospital staff and services, pediatricians, orthopedists and infectious diseases specialists [ 18 ].
The main objectives of nursing care; to avoid possible complications, reduce pain, to inform the children and their families about the process of the disease and the treatment management. In the acute stage of the disease, restriction of movement may be observed in the affected joints.
However, by supporting the affected joint, the child will be in a comfortable position. Cautiously and gently moving the patient will reduce the pain. Pain treatment will relieve the patient. Vital findings are taken and recorded. If important changes may occur in the measurements, then this is shared with the team members [ 19 ]. In the antibiotic treatment, careful observation should be performed; the vascular pathway area and the intravenous sets should be observed. Generally, several antibiotics are used together.
One should consider that the used drugs are compatible with each other. The use of drugs that are not compatible should be avoided. For long-term antibiotics treatment, intermittent infusion devices or a central catheter PICC with peripheral input is used. The antibiotics therapy is often continued at home [ 19 ]. Isolation should be applied to children with an open wound. In wound care, the prescribed medicines are used. In addition, the insertion of antibiotic solutions into the wound care is very effective [ 19 ].
The received-removed fluid amount is continuously measured and recorded. Moreover, the wound drainage is also recorded. The state of healing of the wound tissue is evaluated and recorded [ 19 ]. To provide immobility, plaster is used and in such cases, routine plaster maintenance is performed [ 19 ]. The following are among nursing initiatives: Teaching the child to walk with crutches when necessary, ensuring that the child is kept away from slippery floors, preventing the child from moving in an uncontrolled manner during risk of insufficient mobility due to the plaster, and during the Risk of Trauma due to the dangers of walking with crutches [ 15 , 19 ].
The family must be warned not to take support from the plaster while lifting the child. Protecting the extremity in plaster from impacts is also among important nursing initiatives [ 19 ].
Risk of Deficiency in the Integrity of the Skin [ 15 , 19 ] as a result of the plaster applying a pressure on the skin surface and its being among important nursing initiatives, the nurses have to prevent the use of heating or cooling devices to dry the plaster because there is the risk of burning the skin under the plaster. Other nursing initiatives are as follows: observing the skin on the side of the plaster every day to see whether there is redness or not.
Applying massage to these areas to prevent skin deficiencies. Placing cotton in these areas to prevent skin irritations. Explaining to the small children why they should not put pencils or other objects to the plaster. Elevating the extremity with plaster in order to prevent edema due to the pressure of the plaster. Following the extremity with plaster to see whether there are coldness, color change, edema, pain or numbness or not being able to check the pulse in the distal of the extremity and making neurovascular assessments [ 19 ].
It may be necessary to explain to the parents and to the child that the plaster will not prevent the daily care activities such as toilet need in the morning and general body cleaning [ 19 ].
In Management of the Therapeutical Regime without Effects [ 15 , 19 ], the important factors are, the maintenance of the plaster, the symptoms and findings of the complications, information on the use of helping-supporting devices. In case an area under the plaster itches, ensuring that cold air is blown is another nursing initiative.
In case bad smell comes from below the plaster or the drainage area, its possibility of being a clue for an infection must be explained to the parents of the child.
The knowledge that if the neurological and circulatory functions are broken, this might cause to permanent paralysis in extremities, to ischemia or damage in the nerves must be given to the parents. The information that, in case the plaster is near the perineum area, the plaster must not get dirty with the feces or the urine must be given to the parents as well.
In addition, the parents must be informed about the situation when the plaster is removed, there might be dryness and peeling on the skin [ 19 ]. The affected area, whether in plaster or not is evaluated for color, edema, heat and sensitivity [ 19 ]. In the first stage of the treatment the child has no appetite.
For a healthy diet, until the patient feels better, one is encouraged to consume high calorie liquids, fruit juice, ice cream and jelly. In order to have bone growth and healing, an adequate nutrition has to be provided [ 19 ]. After the treatment in the acute stage, the child will feel better. For this reason, the nurse may start entertaining and curative activities for the children in this period.
However, these activities should be mostly in bed. Because resting of the child usually after the acute period is imperative. However, when isolation and bed-rest may not be required for a long term, moving in a wheelchair may be allowed [ 19 ]. The role of nurses is to provide information to patients and caregivers about the treatment, to support and to help for the treatment plan [ 14 ].
For providing the patient to go through the hospitalization period as comfortable as possible they are encouraged to share their fears and concerns [ 14 ]. Psychosocial evaluation leads to the possibility of self-recognition, coping mechanisms and to reveal the sources of motivation of the patient.
This is for the creation of an appropriate and effective care-plan by the whole team. The patient should be informed about the contents of the processes, that the infection could not be eliminated successfully, risk factors like the development of a new infection, problems related to prolonged bed-rest and regarding a secondary reconstructive surgery.
Patients that have become aware of being not sufficiently informed or being not included in the decision taking will be prone to depression. Regarding the information given, feedback from patients and caregivers should be taken. The preparation of the treatment facilities should be presented; and plenty of opportunities should be given to ask questions frequently [ 14 ]. Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.
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Downloaded: Introduction Osteomyelitis can be described as the inflammation of bone and bone marrow and it usually indicates the presence of an infection. Epidemiology The incidence of osteomyelitis in the first two decades is the highest. Pathogenesis and pathology Osteomyelitis cases among children may occur hematogenously, and more likely the metaphysis of the long bones are involved especially the distal femur, proximal tibia [ 5 , 6 ].
Microorganisms may infect bones in three ways: Direct inoculation trauma, during surgical operation. Hematogenously spreading out bacterial is the most common case.
Etiology The main cause among children at all ages is the Staphylococcus aureus. Clinical table In osteomyelitis, clinical findings vary according to age. Age factor Newborn Form: Among newborns, findings are very weak, when the affected extremity is touched or moved, the baby becomes disturbed.
Specific findings in the bones Long bones: For long bones, acute hematogenous osteomyelitis is typical. Diagnosis Several microbiological, haematological, serological and radiological tests are useful in the clinical diagnosing and the determination of the causative factors of the disease [ 6 ]. Laboratory findings In osteomyelitis laboratory findings are nonspecific. Radiologic findings Conventional radiography for diagnosis of pediatric patients is necessary.
In osteomyelitis, the usual development sequence of radiographic changes is as follows: In the early stages of the disease, the direct radiographs are normal. Differential diagnosis In cases with possible high fever, pain and sensitivity in the extremities, the differential diagnosis should be performed. Treatment The initial treatment can be intense. Antibiotics using principles The basic choice of antibiotics and although the number of comparative studies for the determination of the duration of the treatment is few, antibiotics are the mainstay of the treatment [ 9 ].
Parenteral antibiotic treatment Usually in the beginning of the treatment, to be sure of the harmony and to reach the necessary bone levels, parenteral agents are recommended. Aureus Streptococci H. Table 1. Table 2. Oral antibiotics treatment Patients will be treated with intravenous antibiotics for days. Surgical debridement and drainage should be performed in a suitable manner.
Table 3. Surgical drainage Nearly all of the hematogenous osteomyelitis will heal without surgery when treated with suitable doses of antibiotics. The surgical indications include the following: Diagnosis: When pathogens are not determined in blood cultures for sure, diagnostic aspiration should be performed routinely.
The neurological complications of vertebral or cranial osteomyelitis. Prognosis The treatment results of children with acute hematogenous osteomyelitis who do not have complications are fine.
Chronic osteomyelitis The patient was previously treated for osteomyelitis at the same location. Other advantages of the system: To provide the most appropriate concentration of the antibiotics in the area of the infection, 2 or more couples of lumen tube are used. Before the tubes are removed, the criteria that are expected to be achieved are the following: Clean washing water Zero cavity dimensions In the washing water samples taken in sequence, no breeding of organisms should be observed Stable blood parameters [ 14 ].
Tuberculosis osteomyelitis Primarily it is seen among adults, and the occurrence among children is rare. Clinical Sports Medicine Collection. Davis AT Collection. Davis PT Collection. Murtagh Collection. About Search. Enable Autosuggest. You have successfully created a MyAccess Profile for alertsuccessName.
Previous Chapter. Next Chapter. Grad Y. Grad, Yonatan H. Chapter Osteomyelitis and Septic Arthritis. McKean S. Sylvia C. McKean, et al. Principles and Practice of Hospital Medicine. McGraw Hill; Accessed November 12, McGraw Hill. Download citation file: RIS Zotero. Reference Manager. Autosuggest Results.
What treatment options should be considered? Very occasionally , an early recurrence of infection can be aborted with prompt intensive antibiotic treatment. Perhaps the best guides for choosing an antibiotic, if available, are the results of cultures from previous recurrences. Such a trial of antibiotics should be considered, if a patient presents in the early stages of recurrence, prior to wound breakdown, or is not fit for surgical exploration.
If the infected fracture has not united infected or septic non-union , two approaches can be followed:. Whereas in acute haematogenous osteomyelitis, treatment with antibiotics alone can be considered, fracture wound infection always requires surgery, and antibiotics are to be regarded as adjuvant therapy. Authors of special consideration Rick Buckley , Chris Colton. Recurrent osteomyelitis Principles Neglected fracture-site infections may manifest themselves intermittently, with episodes of symptomatic inflammation pain, redness, swelling and perhaps the development of a discharging sinus , separated by periods of reasonable comfort and function.
Treatment Microbiological cultures of the infected tissues, or PCR , are essential for correct identification of the responsible bacteria and appropriate choice of antibiotics.
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