V. Reference basis of actions

The technician of methodical dosed percussion of bone at acute hematogenous osteomyelitis.

For establishment of hearth of osteomyelitis the careful pattering is needed above a bone. A pain syndrome finds out pattering in the area of heel bone on the ax of extremity. Appearance of acute pain in one of metaepiphysis specifies on localization of acute purulent inflammation in a bone. In more late terms skin covers above the staggered part of extremity become tense, infiltrated, and then hyperemia. At palpation infiltrate of soft tissues, sickliness and local hyperthermia is determined. At the comparative measuring of extremities the increase of volume of the staggered extremity, conditioned an increasing edema, is determined in symmetric areas.

Roentgenologic signs of osteomyelitis

The first changes a bone are usually determined from the 2th week of disease as disappearance of structure of spongy and crust matter of bone, the hearths of limited osteoporosis and destruction appear after. Hearths most often strike of bone metaphysis and have an oval and extended form.

At the same time repair processes are set as a periostitis reaction, showing up a bulge and removing a layer by the layer of periosteum. The changes of it arise up foremost near epimetaphysis and spread towards diaphysis as a longitudinal strip.

Linear periostitis – pathognomonic roentgenologic sign of osteomyelitis. The expressed a periostitis reaction is stipulated localization of osteomyelitic hearth: most it appears at the defeat of diaphysis, less – at inflammation of epiphysis. At the beginning periostitis arises up from one side of bone, here is smooth external and slightly uneven internal contour. There is removing a layer by the layer of periosteum and destruction of it at forming of subperiosteum abscess.

On 14-21 days of disease the roentgenologic picture of acute hematogenous osteomyelitis becomes most distinct. Proceeding necrosis and dispersal of bone tissue stipulate on the roentgenograms thinning of crust matter of bone strengthening of osteoporosis. Inflammation passes on diaphysis, increasing the number of hearths and area of destruction. At progress of inflammatory process all of bone becomes porosity, transparent; the hearths of destruction meet, forming separate cavities. A surplus periostitis reaction develops at high repair properties of periosteum.

To approximately to 30th days destruction of bone ends with formation of one or a few cavities sequestra are usually disposed in which – the torn away necrotize bone fragments. Sequestra – second pathognomonic roentgenologic sign of acute hematogenous osteomyelitis.

Varied diagnostics of acute hematogenous osteomyelitis (aho)

Symptoms of AHO	Fracture	Rheumatism	Erysipelas	Sarcoma of Ewing	Dislocation	Intermuscular phlegmon
1. Bend contracture	+	–	–	–	+	–
2. High t° of body	–	–	+	+	–	+

Technique of endosteal puncture with the purpose of diagnostics and treatment of osteomyelitis.

Urgent screening-test is in diagnostics of acute hematogenous osteomyelitis. Principle of early diagnostics of acute hematogenous osteomyelitis (AHO). The last is limited by 3 hours within the limits of which a duty doctor must reject or confirm a diagnosis.

Conducting the general inspection of patient, at suspicion on AHO palpation, percussion and thermometry of skin is outline localization of hearth of inflammation from four sides. Then under general anaesthesia in the center of quadrangle do the notch of skin and under the corner of 70-80° to the surface soft tissues punctuate by a needle-cannula with thermoelectrode. Determine a endosteal temperature and temperature of periosteum. After it in the needle of thermoelectrode replace the needle of Dyufo or Kassirsky for the fence of bioptate. Osteopuncture conduct, a needle with marrowy bioptate is deleted for conducting cytological, bacteriological and bacterioscopic researches, including the in-high-quality analysis of microbial flora on 1 g of bone tissue.

Then with the purpose of determination of scopes of distribution of inflammation other needle-cannula punctuate a bone in the second point, on 5 sm distal first or, setback on 1 sm from the visible changes of skin. Conduct the analogical stages of screening-test.

Basic testimonies to conducting of urgent screening-test it is been suspicion on AHO (in a projection of bone the presence of pain syndrome in combination with the least increase of temperature of body) and necessity of him varied diagnostics with a trauma, arthritises and other diseases.

Absolute proof of acute hematogenous osteomyelitis is obtaining of pus at osteopuncture.