The term refers to a chronic condition that involves an extensive loss of bone tissue.

Osteomyelitis

Frederick M. Azar MD, in Campbell's Operative Orthopaedics, 2021

Non-hematopoietic Neoplasms of the Bone Marrow

Elaine S. Jaffe MD, in Hematopathology, 2017

Chronic Osteomyelitis

Chronic osteomyelitis is characterized by increased inflammatory neutrophils, lymphocytes, and plasma cells; often fibrosis; and the presence ofsequestrum (infected dead bone) andinvolucrum (a surrounding formation of new bone). In acute osteomyelitis, pus often perforates the periosteum and forms a sinus tract to the skin. With healing, the epithelium of the sinus tract may become entrapped within the bone and form inclusion cysts or even, eventually, squamous carcinoma.

Epithelial inclusions are also often seen as artifacts of bone marrow biopsies. If the central trochar of a biopsy needle is not firmly in place when the needle is pushed through skin overlying the biopsy site, fragments of skin or other dermal or subcutaneous structures can end up adjacent to or appearing to be within the bone marrow space in histologic sections. “Floaters” from other biopsies can appear in sections and may be suspected when there is space between unexpected tissue and the bone marrow biopsy. If this is suspected, it may be wise to repeat the procedure.

Patients with history of normal skeletal development but skeletal pain or fracture and radiologic evidence of osteopenia may have metabolic bone disease. Active osteoporosis (with accelerated bone turnover) shows increased osteoid formation with increased proportion (>20%) of trabeculae showing osteoid seams of normal width. Greater than 4 collagen layers of lamellae are present, and bone surfaces contain plump osteoblasts. Increased osteoclasts (>1 to 2 per section and/or clustered) are also present. Peritrabecular fibrous tissue (osteitis fibrosa), similar to that of hyperparathyroidism, may be seen. Inactive osteoporosis (with reduced turnover) shows thin osteoid seams, flattened osteoblasts, and reduced osteoclasts. There is both formation and resorption of bone, but overall decreased loss of bone tissue.

Osteomalacia and rickets (vitamin D deficiency) are abnormalities of calcification. Osteomalacia is histologically difficult to identify and may require fluorescence examination following tetracycline administration; positive results show a decreased deposition of fluorescence. Rickets results in uncalcified masses of cartilage in the growth plate of a child. Hyperparathyroidism, either primary (due to parathyroid adenoma) or secondary (due to renal failure), results in increased osteoclastic and osteoblastic activity with peritrabecular fibrosis, known as osteitis fibrosa (Fig. 58-11). Scurvy (vitamin C deficiency) results in the inability to form osteoid because of abnormal collagen transformation. Calcified cartilage is seen with radiologic evidence of increased density at the growth plate.

Infectious Diseases

Harold Merriman, in Acute Care Handbook for Physical Therapists (Fourth Edition), 2014

Musculoskeletal Infections

Osteomyelitis is an acute infection of the bone that can occur from direct or indirect invasion by a pathogen. Direct invasion is also referred to as exogenous or acute contagious osteomyelitis and can occur any time there is an open wound in the body. Indirect invasion is also referred to as endogenous or acute hematogenous osteomyelitis and usually occurs from the spread of systemic infection. Both of these types can potentially progress to subacute and chronic osteomyelitis. Acute osteomyelitis typically refers to an infection of less than 1 month's duration, whereas chronic osteomyelitis refers to infection that lasts longer than 4 weeks.72,73

Acute contagious osteomyelitis is an extension of the concurrent infection in adjacent soft tissues to the bony area. Trauma resulting in compound fractures and tissue infections is a common example. Prolonged orthopedic surgery, wound drainage, and chronic illnesses, such as diabetes or alcoholism, also predispose patients to acute contagious osteomyelitis.73,74

Acute hematogenous osteomyelitis is a blood-borne infection that generally results from S. aureus infection (80%)3 and occurs mostly in infants; children (in the metaphysis of growing long bones); or patients undergoing long-term IV therapy, hyperalimentation, hemodialysis, or corticosteroid or antibiotic therapy. Patients who are malnourished, obese, or diabetic, or who have chronic joint disease, are also susceptible to acute hematogenous osteomyelitis.72,73

Clinical presentation of both types of acute osteomyelitis includes (1) delayed onset of pain, (2) tenderness, (3) swelling, and (4) warmth in the affected area. Fever is present with hematogenous osteomyelitis. The general treatment course for acute osteomyelitis is early and aggressive administration of the appropriate antibiotics to prevent or limit bone destruction.3,56,72,73

Chronic osteomyelitis is an extension of the acute cases just discussed. It results in marked bone destruction, draining sinus tracts, pain, deformity, and the potential for limb loss. Chronic osteomyelitis can also result from infected surgical prostheses or infected fractures. Debridement of dense formations (sequestra) may be a necessary adjunct to the antibiotic therapy. If the infection has spread to the surrounding soft tissue and skin regions, then grafting, after debridement, may be necessary. Good treatment results have also been shown with hyperbaric oxygen therapy for chronic osteomyelitis.72,73

Clinical Tip

Clarify weight-bearing orders with the physician when performing gait training with patients who have any form of osteomyelitis. Both upper and lower extremities can be involved; therefore choosing the appropriate assistive device is essential to preventing pathologic fracture.

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Infectious Diseases

Basil J. Zitelli MD, in Zitelli and Davis' Atlas of Pediatric Physical Diagnosis, 2018

Chronic Osteomyelitis

With antimicrobial therapy and improved diagnostic techniques, chronic osteomyelitis has become much less common in developed nations. Delay in diagnosis, inadequate antimicrobial or surgical therapy, and resistant organisms are the major factors now associated with chronic disease. Extensive necrosis, sequestrum formation, and decompression caused by fistulization through the overlying soft tissues are characteristic findings (Fig. 13.57). Patients suffer variable local pain and often have chronic draining sinus tracts. Aggressive surgical curettage and long-term antimicrobial therapy are required to achieve resolution, but despite this, permanent functional disability and deformity are not uncommon in chronic osteomyelitis. The major differential consideration for chronic bacterial osteomyelitis is chronic recurrent multifocal osteomyelitis (CRMO), a rheumatologic condition that presents with a similar clinical picture. However, this disorder is characterized by multiple recurrent sites of sterile bone inflammation and responds to anti-inflammatory therapy, and radiologic findings do not reflect the severity of chronic disease.

Inflammatory Jaw Lesions

In Oral Pathology (Sixth Edition), 2012

Etiology

Chronic osteomyelitis with proliferative periostitis, commonly referred to as Garré's osteomyelitis, is essentially a subtype of osteomyelitis that has a prominent periosteal inflammatory reaction as an additional component. It most often results from periapical abscess of a mandibular molar tooth, or from infection associated with tooth extraction or partially erupted molars. It is most common in children.

The eponym Garré's osteomyelitis was applied to this condition after the author, Dr. C. Garré, described in an 1893 German language paper the clinical features of 72 patients with osteomyelitis. The disease that he described was most common in the femur, with only three cases occurring in the jaws. In the absence of histologic and radiographic findings, which were unavailable at the time of the report, it is likely that Garré was describing a form of recalcitrant, acute osteomyelitis that occurred in both adults and children. It was not chronic osteomyelitis with proliferative periostitis. Therefore, the term Garré's osteomyelitis, although widely used in reference to this condition, is inaccurate.

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Bones and Joints

Ivan Damjanov MD, PhD, in Pathology Secrets (Third Edition), 2009

54 What is the pathogenesis of chronic osteomyelitis?

Chronic osteomyelitis results from incompletely healed or persistent suppurative acute infection. Lytic enzymes released from the inflammatory cells cut channels through the bone, leading to the formation of bone fragments that ultimately detach from the main bone mass. Such a piece of dead bone, called sequestrum, may float inside the abscess cavity. The wall of the abscess cavity is composed of newly formed bone, which is called involucrum. Sinus tracts draining the pus from the abscess to the surface of the body are called cloacae. Chronic bone abscess fully enclosed by sclerotic bone is called Brodie abscess.

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Osteomyelitis

David K. Hong, Kathleen Gutierrez, in Principles and Practice of Pediatric Infectious Diseases (Fifth Edition), 2018

Chronic Osteomyelitis

Chronic osteomyelitis develops in less than 5% of cases of AHO.193 More often, it complicates nonhematogenous osteomyelitis.171

Chronic osteomyelitis is characterized by alternating periods of quiescence and recurrence of pain, swelling, and sinus tract drainage. It can persist for years despite prolonged antibiotic therapy. Infections often are polymicrobial, and with skeletal growth, the original metaphyseal infection moves to become a lytic lesion in the diaphysis.163,173

Surgical debridement of necrotic bone is the primary management. Alternative therapeutic approaches include the use of antibiotic-impregnated polymethyl methacrylate beads,194,195 local antibiotic delivery by implantable pumps,196 and suction vacuum devices or bone grafts, skin grafts, and muscle flaps to eliminate dead space and improve vascularity.197

All references are available online at www.expertconsult.com.

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Skeletal System

Johan G. (Hans) Blickman, Geert Vanderschueren, in Pediatric Radiology (Third Edition), 2009

Chronic Osteomyelitis

Chronic osteomyelitis, defined as continuous infection of a low-grade type or of a recurrent type, is characterized predominantly by bony sclerosis, periosteal new bone formation, and the presence of sequestra and/or draining sinuses. It is uncommon in children. CT or MRI defines the extent better than conventional radiographs. If the new bone formation is considerable, the imaging findings are known as Garré sclerosing osteomyelitis, which is due to multiple small foci of repeated infarction at the infection site that result in new bone formation. This entity may occasionally be difficult to distinguish from osteoid osteoma, Ewing tumor, and FD (Fig. 7-42).

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Inflammatory Disease

Linda Lee, in Oral Radiology (Seventh Edition), 2014

Effects on Surrounding Structures.

Chronic osteomyelitis often stimulates the formation of periosteal new bone, which is seen radiographically as a single radiopaque line or a series of radiopaque lines (similar to onion skin) parallel to the surface of the cortical bone. Over time, the radiolucent strip that separates this new bone from the outer cortical bone surface may be filled in with granular sclerotic bone. When this occurs, it may be impossible to identify the original cortex, which makes it difficult to determine whether the new bone is derived from the periosteum. After a considerable amount of time, the outer contour of the mandible also may be altered, assuming an abnormal shape, and the girth of the mandible may be much larger than on the unaffected side. The roots of teeth may undergo external resorption, and the lamina dura may become less apparent as it blends with the surrounding granular sclerotic bone. If a tooth is nonvital, the periodontal ligament space usually is enlarged in the apical region. In patients with extensive chronic osteomyelitis, the disease may slowly spread to the mandibular condyle and into the joint, resulting in a septic arthritis. Further spread may involve the inner ear and mastoid air cells. Chronic lesions may develop a draining fistula, which may appear as a well-defined break in the outer cortex or in the periosteal new bone (Fig. 20-19).

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What is the chronic condition that involves an extensive loss of bone tissue often causing older adults to walk with a marked stoop?

Bone is living, growing tissue that changes throughout the lifespan. Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.

Which of the following health problems is characterized by an extensive loss of bone tissue?

Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency or advanced age.

Is a chronic progressive disease characterized by muscle tremors slowing of movement and facial paralysis?

Parkinson's disease. This slowly progressive disease causes tremor, muscle stiffness, slow or decreased movement, or imbalance.

Which of the following conditions includes chronic progressive disease characterized by muscle tremors?

Parkinson's disease is a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves. Symptoms start slowly. The first symptom may be a barely noticeable tremor in just one hand. Tremors are common, but the disorder may also cause stiffness or slowing of movement.