Osteitis

Ostitis (from the Greek osteon, which means "bone") is a disease characterized by inflammatory processes in the bone tissue.

Such inflammation can develop in it as a result of the impact of traumatic factors or infection, and is mainly associated with fractures or unsuccessfully performed bone surgery. This inflammation is nonspecific. A specific bone inflammation occurs due to the spread of hematogenous tuberculosis, syphilitic, etc. Infections. Under ostitis, in many cases, involve bone lesions that occur with tuberculosis, particularly in tuberculous arthritis.

The course of ostitis is chronic, or it can take an acute form. In acute condition, the bone undergoes destruction, and in case of a chronic disease, the prevalence of proliferation processes is noted. When there is congenital and tertiary syphilis speak of syphilitic, ossifying and resolving osteitis.

Each of the given species of this lesion of bone tissue involves treatment with the application of various appropriate measures. So, in the presence of specific osteitis, the focus of medical measures is primarily directed towards the underlying disease. In other cases, it may be more appropriate to prescribe a surgical treatment for the purpose of sanitizing the focus of the inflammatory process. Operative intervention is accompanied by the use of antibacterial, desensitizing, as well as immunostimulating drugs.

When osteitis is timely diagnosed and the necessary rational treatment is started in the very near future, the prognosis of its course is favorable with a high probability of complete recovery.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Causes of ostitis

The causes of ostitis are represented by two main groups of factors causing the onset of the disease.

The most common of them is a traumatic violation of the integrity of the bone during a stroke, bruise, fracture (open or closed), as well as due to surgical interference with the latter. Fractures conceal the danger that in connection with them a purulent microflora can appear in the wound.

With respect to microflora, it should be noted that its specific types, such as syphilitic and tubercular, are also capable of provoking ostitis. For their reason, respectively, syphilitic and tuberculous ostitis. The explanation for this is that when a person has a disease with syphilis or tuberculosis, infection through the circulatory system can spread throughout the body, affecting, including bone tissue.

In medical statistics, a limited number of cases have also been noted when ostitis occurred against a background of such diseases as brucellosis, gonorrhea, leprosy, paratyphoid and rheumatoid arthritis.

Thus, the causes of ostitis are mainly reduced to mechanical effects of traumatic nature on the bone, and in addition to various factors of infectious pathogenesis. Proceeding from this, depending on the cause of bone inflammation, the inherent ostia is selected the appropriate method of treatment.

[13], [14], [15], [16], [17]

Symptoms of ostitis

Symptoms of ostitis and the degree of their severity are determined by the nature of etiology, the extent of the prevalence of the pathological process, what objectively the general condition of the patient, and also notes whether any associated diseases and impaired functioning of the organism have appeared in connection with ostitis.

Progression of otitis can often occur without giving out its presence by any noticeable manifestations until the time when at some point there will be an exacerbation.

As a rule, acute ostitis is accompanied by the appearance of local pain symptoms. Subsequently, there is some puffiness, the functioning of the affected area of the limb or the spinal column changes negatively. Do not exclude the possibility of pathological fractures, the formation of secondary deformations. There are violations of the nerves and spinal cord, which is characteristic of spondylitis, that is, tuberculosis of the spine. If the inflammatory processes involved are periosteum and soft tissues, then fistula and phlegmon appear.

Ostitis in chronic form can represent, in essence, further development of chronic periodontitis. In this case, the disease manifests itself in the form of thickening of the jawbone bearing a one-sided or two-sided nature. At the same time, significant portions of the jaw can be involved in this process. Up to the point that the entire half of it is on the right or left, depending on the location of the otitis.

The occurrence of exacerbations is noted under certain circumstances as a result of unfavorable conditions. These include catarrhal diseases, stress conditions, etc. The clinical picture in this case is analogous to an acute process. As for the time factor, it seems possible to reveal it only on the basis of anamnesis and roentgenograms.

Symptoms of ostitis can be completely implicit, and the presence of the disease is often determined only at the stage of its exacerbation. Proceeding from this, great importance is the diagnosis in the early stages of development of such bone inflammation, since without appropriate treatment, osteitis can differ in the tendency to a significant spread of the lesion in the human body.

BCG osteitis

BCG vaccine was first used in 1923. Subcutaneous injection of the drug has been practiced since 1962 and since then it remains the only way to vaccinate against tuberculosis. BCG is a Russian-language transcription of BCG, abbreviations from Bacillum Calmette Guerin, as the culture is called by the names of its creators, which became French scientists A. Calmette and S. Guérin.

Vaccination with the use of BCG helps prevent the development of tuberculosis in its most severe forms, which have tuberculous meningitis and lightning-fast tuberculosis. Each year, this vaccine is given to up to 100 million children.

However, with the use of this vaccine, it is still impossible with absolute assurance to be sure that it will not cause any possible post-vaccination complications. And although they are reflected in extremely small numbers (0.004-2.5%), nevertheless, there are places to be.

Along with the most common negative consequences manifested in the defeat of regional over- and subclavian, axillary, cervical lymph nodes, it is now also noted that BCG osteitis often develops after inoculation.

It is generally believed that the main reasons for this lie in the possible unfair attitude of the person conducting the manipulation, in violating the technique of its execution. This may be, too much depth of administration of the vaccine over the skin or dose exceeding the prescribed rate. The consequences of such actions can cause a variety of negative local reactions in the form of necrotic phenomena in the tissues, the occurrence of ulcers, lymphadenitis, keloid and cold abscess, as well as lupus in the place where the vaccine was administered.

To lead to the appearance of BCG ostitis can also carry out vaccination without taking into account existing contraindications, when this vaccination is unacceptable due to the individual characteristics of the response from the immune system of the child.

BCG osteitis, as well as many other possible negative responses of the child's organism to vaccination can be excluded only if entrusted to conduct the expedition to a qualified specialist.

[18], [19], [20], [21], [22],

Tuberculous osteitis

Tuberculosis osteitis is characterized by an inflammation of a specific type, which mainly has places of occurrence in the human skeleton of those parts in which there is a large number of red, hematopoietic, myeloid bone marrow.

In the largest step, the lesion occurs in the bodies of the vertebrae, in metaphytes of the tibia, femur and humerus. The bodies of the lumbar, iliac, ischial bones are also subject to the development of this disease.

The localization of inflammation is predominantly solitary, but sometimes such lesions can sometimes occur in several parts of the skeleton.

Regarding the age of a person in whom there is a high probability of the appearance of this disease, the period of childhood and adolescence is at risk.

Foci of inflammation with the greatest frequency are noted in the immediate vicinity of the joints, which, under a certain cross-section of circumstances, can become a factor causing the possibility of spreading to a nearby joint. In the absence of appropriate treatment, this can be exacerbated by the appearance of inflammation in the synovial membrane of the joint capsule. On the other hand, if the focus of inflammation in tuberculous ostitis is at a distance from the joint, then its encapsulation is possible, but this can happen only if the human body has good resistance.

Tuberculosis osteitis is characterized by a long time of development and course of the pathological process and in the early stages is not accompanied by any significant pain symptoms, which often does not cause any anxiety in the patient. But here lies the main danger of this disease. After all, this is why many people for a long time break the beginning of treatment, which leads to a very unfavorable result in togel.

Mandibular osteitis

The osteitis of the jaw is a disease in which inflammatory processes occur in the bone tissue. Frequent concomitant with this phenomenon is also an inflammation of the periosteum, which is called periostitis. In addition, phlegmon and fistula can form, as well as bone marrow inflammation-osteomyelitis.

On the onset of osteitis of the jaw may indicate the appearance of soreness, in any part of the jaw. Further in that place there is some puffiness that causes the arising difficulties in the process of chewing food. And later, pain sensations are already noted throughout the jaw.

Lead to this disease can be severe mechanical damage with bumps, injuries, bruises from which there was a fracture of the jawbone. The reasons are also the consequences of an unsuccessful surgical intervention.

To appear in the jaw, ostitis is able because in a number of diseases, for example, with tuberculosis and syphilis, hematogenous infection occurs throughout the body.

The treatment is based on an integrated approach and consists of conducting an operative intervention in conjunction with the prescription of antibacterial and immunostimulating agents. The presence of a common infectious disease requires the priority of its cure.

The osteitis of the jaw is a very unpleasant disease that can be caused by both traumatic and infectious factors and requires rather radical medical measures to treat it.

Fibrous osteitis

Fibrous osteitis is one of the possible complications associated with the course of the disease by hyperparathyroidism, where the bones undergo softening and deformation. Hyperparathyroidism is characterized by the fact that parathyroid hormone is produced in it in an amount significantly exceeding what is necessary for the normal functioning of the body. As a result, calcium-phosphorus metabolism is disrupted, and osteoclastic processes are intensified, during which phosphorus and calcium are excreted from the bones. However, as a result of the fact that the tubular absorption decreases and phosphorus begins to release with more activity, hyperphosphaturia and hypophosphatemia occur.

Changes related to bone tissue consist in the appearance of osteomalacia and osteoporosis.

Bones become brittle, which causes an increased predisposition to fractures in the upper and lower extremities, and in addition to spinal injuries.

According to the results of blood tests during the disease, a high content of calcium, alkaline phosphatase is fixed. Parathyroid hormone is also present in large amounts. The phosphorus index is lower. X-ray examination reveals thinning of bones, violation of their integrity in the form of cracks and fractures, cyst formation is noted.

In most cases of fibrous osteitis, its course is not associated with the appearance of any obvious specific symptomatology, it can appear only in complications. This, however, should in no way inspire confidence that if fibrous ostitis does not disturb and does not significantly affect health, it is something that does not pose a threat to health. It, like any other disease you need to treat.

[23], [24], [25], [26], [27]

Condensate ostitis

Condensating osteitis is an inflammatory process that encompasses all parts of the bone at the same time: bone as such - osteitis, periosteum, called periostitis, and myelitis - inflammation developing in the bone marrow. A specific feature of it is that it has a focal sclerosing nature and its course occurs in a chronic form.

The etiology of condensation osteitis is associated with the appearance of an atypical reaction of bone tissues in those patients who have high resistance or with low infection, especially at a young age.

This disease is most often localized in the area where the lower premolars are located. The removal of the tooth does not lead to the disappearance of sclerotic changes. The presence of insignificant rims of osteosclerosis sometimes occurs as a result of compensated occlusal overload, which is not due to a connection with the earlier processes in the periodontal inflammatory processes

The pathomorphological changes caused by condensing ostitis can be characterized as one of the successive stages in which the aseptic process develops, leading to osteoporosis, that is, bone destruction, and osteosclerosis, in which bone density increases.

Based on all of the above, we come to the conclusion that condensing osteitis is a chronic disease characterized by the spread of pathological progress in vast areas involving the sclerosing processes of both the bone itself, bone marrow and periosteum. In view of this, its presence may require rather serious medical and preventive measures.

[28]

Diagnosis of osteitis

Diagnosis of osteitis is mainly carried out on the basis of information on the state of bones obtained as a result of X-ray examination.

On roentgenograms, ostitis looks like foci of destructive changes in compact or spongy bone substance, which differ in shape. These foci have dimensions of several millimeters, and can be measured in centimeters. The edges are either clear or indefinite. Sometimes the presence of an osteosclerotic reaction in the surrounding bone tissue is detected, in the hearth inside there is a shadow of the sequester.

Tuberculosis ostitis is characterized by the fact that bone tissue exhibits a predominantly weakly expressed productive reaction, which looks like a narrow sclerotic rim surrounding the source of destruction. When otitis tubercular type, a spongy sequester forms.

Bone inflammation, which has its origin in the metaphyseal region, with an eccentrically located focus, mainly in children, can be a prerequisite for a laminated or linear periosteal reaction characterized by tuberculous osteitis. In this case, for accurate diagnosis using a tomography.

Diagnostic measures for ostitis also include a radionuclide study to accurately detect the localization of inflammation, when the x-ray is untenable. This helps to determine the choice of a place in which to perform a biopsy of bone tissue.

Specific ostitis is diagnosed by immunological and microbiological methods.

Diagnosis of osteitis is necessary to maximally differentiate this disease from dystrophic degenerative cysts, cortical lacuna, limited aseptic necrosis, osteoid-osteoma, chondroblastoma, eosinophilic granuloma, etc. The establishment of an accurate and unambiguous diagnosis is a positive factor for an effective treatment process and successful recovery .

[29], [30], [31], [32]

X-ray diagnosis of tuberculous osteitis of the hip joint

The hip joint is one of the most frequent places in the human body, where osteoarticular tuberculosis is affected. On this basis, the detection of the disease at the earliest stage of its development becomes relevant, which greatly facilitates the process of treatment and minimizes subsequent complications. Diagnostic measures in many cases are carried out using X-ray research. In particular, X-ray diagnosis of tuberculous osteitis of the hip joint is performed.

According to the radiography data, the earliest studies show signs of osteoporosis, and it is possible to identify them only when comparing the images on which both hip joints are covered. Even at the stage leading to tuberculous osteitis, there may be a change in soft tissues manifested as increased shadows of intermuscular layers in the contours between the joint bag and the middle and small muscles of the buttocks. There may be an asymmetric arrangement of pelvic bones due to the fact that a person assumes an incorrect position due to muscle atrophy, either from thickening of the joint from the diseased side, or from a contracture of a painful nature.

At the expiration of one and a half to two months on the radiographs appear the emergence of foci of destructive processes in the bone tissue, the edges of which are uneven and fuzzy, and in which there is a presence of multiple spongy sequesters.

Tuberculosis osteitis with the highest frequency occurs in those bones that they formed the acetabulum, to a lesser degree this disease is detected in the neck of the thigh, and extremely rarely in the head of the hip bone. In regard to the latter, it should be noted that they are better seen on radiographs, during which the hip is outwardly away. In the acetabulum, the identification of foci of bone tissue destruction is facilitated by obtaining posterior radiographs.

In some cases, the patient can identify early deformation of the nucleus, ossification and an increase in the head of the thigh.

X-ray diagnostics of tuberculous osteitis of the hip joint is carried out at different stages of the course of the disease, which allows to reveal the dynamics of the pathological process and, based on this, if necessary, make certain adjustments to the plan of treatment measures, which is aimed at improving the prognosis and increasing the possibility of effective cure.

Treatment of ostitis

Treatment of ostitis consists in carrying out a complex of medical measures that are selected in each case based on the etiology and the reasons that they are caused by the development of the disease. As a rule, surgical intervention is carried out for the removal of affected tissues that have undergone necrotic processes - necroectomy. This method of surgical treatment is indicated for otitis tuberculosis type. In addition, to remove those fragments of bone called sequesters that have separated from the bone due to the disease, sequestrectomy is performed. Segmental and longitudinal resection of bones, treatment of their cavities by vacuum and ultrasonic method, application of intake and suction drainage can also be expedient.

Therapeutic treatment measures for osteitis are to carry out antimicrobial therapy using antibiotic drugs, sulfonamides. In the chemotherapy, effective antiseptics are prescribed, not excluding the use of specific, intramuscular and intravascular way, inside and locally. Proteolytic enzymes such as papain, chymotrypsin, etc., have become widespread.

Not the least role in the treatment of ostitis is played by passive and active immunization, physiotherapy procedures. Also the affected limb should be immobilized.

Thus, treatment of ostitis is mainly carried out in a hospital and is prescribed based on the etiology and nature of the disease, as well as the general condition of the patient. Based on the combination of these factors, the doctor chooses in favor of one or another method and develops the most appropriate and effective scheme of medical measures.

Prevention of otitis

Ostitis in its specific form often arises due to the presence in a person of a number of diseases, such as for example syphilis. Tuberculosis, etc. In such a case, the whole organism undergoes a hematogenous way through the blood flow in the circulatory system. Including infection gets into the bone tissue, where it provokes inflammation.

Thus, the prevention of ostitis, while assuming a primary need to take the necessary medical measures aimed at treating this underlying infectious disease. It is of great importance here to start treatment as soon as possible in the shortest possible time after the person has been diagnosed with the corresponding infection. Early onset treatment greatly contributes to preventing its ubiquitous spread.

To prevent ostitis of traumatic origin, this implies first of all a primary treatment of an open fracture, as well as an unswerving adherence to the principles of observing the strictest aseptic conditions for osteosynthesis of closed fractures.

Summing up what should be the prevention of ostitis, we emphasize two basic principles. First of all, it is the necessity of compulsory treatment of acute forms of diseases in order to prevent their transition to chronic form. And another prerequisite is adequate sanitation with damage to the integrity of bones in cases of strokes, injuries, bruises and fractures, especially open ones. To avoid getting pathogenic microorganisms and infection.

Forecast of osteitis

The prognosis of ostitis, in the case when the appropriate rational treatment is started in its timely detection, is advantageously favorable.

[33], [34], [35]