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A similar form of osteomyelitis may occur apart from a wound for example, infection may spread to the jaws from lesions of the mouth; to the skull, from lesions of the scalp or of the cranial bones themselves such as a syphilitic gumma or a sarcoma which has fungated externally; or to the petrous temporal, from suppuration in the middle ear.
#Pyogenic Osteomyelitis due to Spread of Infection from the Soft Parts.# There still remain those forms of osteomyelitis which result from infection through a wound involving the bone for example, compound fractures, gun-shot injuries, osteotomies, amputations, resections, or operations for un-united fracture.
While the occurrence of purely periosteal suppuration is regarded as possible, we are of opinion that the embolic form of staphylococcal osteomyelitis always originates in the marrow.
With few exceptions, tuberculous disease in the interior of a bone does not reveal its presence until by extension it reaches one or other of the surfaces of the bone. In the shaft of a long bone its eruption on the periosteal surface is usually followed by the formation of a cold abscess in the overlying soft parts. Diffuse Tuberculous Osteomyelitis of Right Tibia.
In the human subject, multiplication in the blood-stream does not occur to any great extent. In some general acute pyogenic infections, such as osteomyelitis, cellulitis, etc., pure cultures of staphylococci or of streptococci may be obtained from the blood. In pneumococcal and typhoid infections, also, the organisms may be found in the blood.
#Circumscribed Abscess of Bone "Brodie's Abscess."# The most important form of relapsing osteomyelitis is the circumscribed abscess of bone first described by Benjamin Brodie. It is usually met with in young adults, but we have met with it in patients over fifty. Several years may intervene between the original attack of osteomyelitis and the onset of symptoms of abscess. Morbid Anatomy.
The shadow of the new case or involucrum with its wavy contour is also in evidence, with its openings or cloacæ, and is mainly responsible for the increase in the diameter of the bone. The skiagram may also show separation and displacement of the adjacent epiphysis and destruction of the articular surfaces or dislocation of the joint. Sequelæ of Acute Suppurative Osteomyelitis.
The clinical features of osteomyelitis in an amputation stump are those of ordinary pyogenic infection; the involvement of the bone may be suspected from the clinical course, the absence of improvement from measures directed towards overcoming the sepsis in the soft parts, and the persistence of suppuration in spite of free drainage, but it is not recognised unless the bone is exposed by opening up the stump or the changes in the bone are shown by the X-rays.
The diagnosis of Brodie's abscess from other affections met with at the ends of long bones, and particularly from tuberculosis, syphilis, and new growths, is made by a consideration of the previous history, especially with reference to an antecedent attack of osteomyelitis. When the adjacent joint is implicated, the surgeon may be misled by the patient referring all the symptoms to the joint.
The X-ray appearances of the bones affected are of a striking character; apart from the outgrowths of bone or "tumours" there is evident a widespread alteration in the internal architecture of the bones, which suggests analogies with other disturbances of ossification such as achondroplasia and osteomyelitis fibrosa.
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