* OSTEOMYELITIS,

BONE TUMORS,
AND MUSCULAR
DYSTROPHY
Ms. Rumana Shazmeen
MSc (N) 1st year
OSTEOMYELITIS
 DEFINITION
Osteomyelitis is an infection of the bone; it includes the long bones, of
the arms and legs
According to Brunner
Inflammation of the bone caused by an infection, which may spread to
the bone marrow and tissues near the bone
According to Lewis
Osteomyelitis is a severe infection of the bone, bone marrow, and
surrounding soft tissue
According to Blacks
 TYPES
ACUTE CHRONIC
Duration Infection
of that
infection persists
less than longer
1 month than one
month
 WEILAND CLASSIFICATION OF
OSTEOMYEITIS

• OPEN WOUND , NO OSSEOUS

INFECTION,EVIDENCE OF SOFTTISSUE
TYPE I INFECTION

• CORTICAL , ENDOSTEAL INFECTION DIFFUSE

INFLAMMATORY RESPONSE
• ASSOCIATED WITH SEQUESTRUM WITH
TYPEII SURROUNDING INVOLUCRUM

• CORTICAL ENDOSTEAL INFECTION, WITH

TYPE III BONE DEATH
 ETIOLOGY

OPEN
FRACT
URE

PRESS STAPHYLOCOCCU
PENETR
URE S AUREUS
ATING
ULCER WOUND

OTHOPEDI
C SURGRY
AND
VASCULAR
INSUFFICU
ENCY
 CONTD…

MYCOBACTER
STAPHYLOCO STAPHYLOCC
IUM
CCUS OUS
TUBERCULOSI
EPIDERMIDIS VIRIDIANS
S
 CONTD…

PROLONGE
PSEUDOMO PUNCTURE
USE OF IV
NAS WOUND
DRUG
 CONTD…

SALM
ONELL INFECTION
A
SICKL
E
ANEMIA CELL
DISEA
SE

FUNGI INFECTION
 GENITO
URINARY
IN DIRECT RESPIRATOR
RESPIRATOR
(HEMATOG Y
Y
ENOUS)
MODE OF BONE
ENTRY
OPEN
DIRECT
WOUND
 PATHOPHYSIOLOGY
Due to etiological factors

After gaining entry into the blood, the microorganisms grow

Resulting in an increase in pressure because of the nonexpanding nature of

most bone.

This increasing pressure eventually leads to ischemia and vascular

compromise of the Periosteum.

The infection spreads through the bone cortex and marrow cavity, ultimately
resulting in cortical DE vascularization and necrosis.

Once ischemia occurs, the bone dies.

 CONTD…
The area of devitalized bone eventually separates from the surrounding living
bone, forming sequestra.

The part of the Periosteum that continues to have a blood supply forms new
bone called involucre

It is difficult for blood-borne antibiotics or white blood cells (WBCs) to reach

the sequestrum.

A sequestrum may become a reservoir for microorganisms that spread to

other sites, including the lungs and brain.

If the sequestrum does not resolve on its own or is debrided surgically, a sinus
tract may develop, resulting in chronic, purulent cutaneous drainage.
 CLINICAL
MANIFESTATIONS
STAGES
[ACUTE]
LOCAL

SYSTEMIC

LATER
 LOCAL

WARMTH AT
THE
SWELLING TENDERNESS
INFECTION
SITE

RESTRICTED
NAUSEA
MOMENT
SYSTEMIC

CHILLS
NIGHT SWEAT
FEVER
RESTLE
SSNESS
 LATER

DRAINAGE FROM THE

FRACTURE SITE
FEATURES OF CHRONIC
OSTEOMYLITIS

SACR
TISSUE
CONSTAN
T BONE FORMAT
SWELLIN PAIN ION
G
 DIAGNOSTIC EVALUATION
1.
• HISTO

2.
RY • CO
COLLE • BON
CTION E MPL
PHYSIC BIO ETE
AL
EXAMI PSY BLO
NATIO OD
N STU
DIE
 CONTD…

RADIO NUCLIDE
X-RAY BONE SCAN

MRI CTSCAN
BONESCAN RESULT
DIFFERENTIAL DIAGNOSIS

EWINGS
SARCOMA

SEPTIC
ARTHIRITIS

SICKLE CELL
ANEMIA
 MANAGEMENT
NON
PHARM
ACOLO
GICAL

MAN PHARM
NURSIN
G AGEM ACOLO
GICAL
ENT

SURGIC
AL
NON PHARMACOLOGICAL
MANAGEMENT

NEGATIVE
PRESSURE
WOUND
THERAPY

HYPERBARI
C OXYGEN
 PHARMACOLOGICAL MANAGEMENT
 PENCILLIN
Nafcillin (Nafcil)
Neomycin
 CONTD…
 Vancomycin,
 Cephalexin (Keflex)
 Cefazolin (Ancef)
 Cefoxitin (Mefoxin)
 Gentamicin (Garamycin), and
 Tobramycin (Nebcin)
SURGICAL MANAGEMENT

DRAIN THE
INFECTED AREA

DEBRIMENT
SURGICAL MANAGEMENT

MUSCLE FLAPS

AMPUTATION
 COMPLIMENATARY AND ALTERANTIVE THERAPIES

Vitamin C, Vitamin A, Vitamin E helps to boost

immune system
HERBS- garlic, ginseng, barberry helps the
abscesses to heal
ACUPUNCTURE- may help stimulate the immune
system, by reducing inflammation, swelling and
fever
 NURSING DIAGNOSIS
 Acute pain related to
inflammatory process secondary
to infection
 Ineffective self–health
management related to lack of
knowledge regarding long-term
management of osteomyelitis •
 Impaired physical mobility
related to pain, immobilization
devices, and weight-bearing
limitations
 COMPLICATIONS

 Septicemia
 Septic arthritis
 Pathologic fractures, and
Amyloidosis
 DEFINITION
Bone cancer is an uncommon cancer that begins in a bone, it can
begin in any bone in the body, but most commonly affects the long bones
that makes up the arms and legs
According to Lewis
A bone tumor is a abnormal growth of cells within a bone, which may
be cancerous or non –cancerous Metastasis to the bone should be
suspected in any patient who has local bone pain and a past history of
cancer
According to Brunner
TYPES OF BONE TUMOR

BENIGN

MALIGNANT

METASTATIC
 TYPES OF BENIGN TUMOR

OSTEO OSTEO ENDOCH

1.

2.

3.
ROMA
CHOND CLASTO
ROMA MA
 CLINICAL MANIFESTATION OF
OSTEOCHONDROMA

 A painless, hard, immobile mass

 Lower-than-normal height for age
 Soreness of muscles in close proximity to the tumor
 One leg or arm longer than the other; and
 pressure or irritation with exercise
Patients may also be asymptomatic
DIAGNOSTIC EVALUATION
OF OSTEOCHONDROMA

1.
•X-RAY

2.
•CT-SCAN

3. •MRI
 TREATMENT OF
OSTEOCHINDROMA

NO
SPECIFIC
TREATME
NT
 OTHER BENIGN TUMORS CONTD…

Osteoclastoma (giant cell tumor) –Arises in cancellous ends

of arm and leg bones
• About 10% are locally aggressive andmay spread to lungs
• High rate of local recurrence after surgery and
chemotherapy
Endochroma –Intramedullary cartilage tumor usually found in
cavity of a single hand or footbone
• Rare malignant transformation can occur
• If tumor becomes painful, a surgical resection is done
• Peak incidence in persons ages 10-20
Types of malignant bone tumors
MALIGNANT TUMOR IS
CHARACTERISED

1.

METASTASIS
CONTD…

2.Bone
destruction
 CONTD…

BONE
DISTRUC
TION

MALIGNANT
BONE
TUMOR

METAST
ASIS
 OSTEOSARCOMA
 Osteosarcoma is a primary malignant bone tumor that is
extremely aggressive and rapidly metastasizes to distant
sites.
 It usually occurs in the metaphyseal region of the long
bones of extremities, particularly in the regions of the
distal femur, proximal tibia, and proximal humerus, as well
as the pelvis
 Osteosarcoma is the most common malignant bone tumor
affecting children and young adults.
 It can also occur, but not as commonly, in older adults. It is
most often associated with Paget’s disease and prior
radiation.
CLINICAL MANIFESTATION

1. pain

2.Swelling
especially
around the
knee

3.10-20% of
individual are
metastasis when
they are
diagnosed with
osteosarcoma
DIAGNOSTIC EVALUATION
EVALUATION OF
SERUM
PHOSPHATE X-RAY
AND CALCIUM
LEVEL

X-RAY,PET
CT-SCAN,MRI
SCAN

TISSUE
BIOPSY
TREATMENT
RADIATIO
N
THERAPY

CHEMOTH
ERAPY

SURGICAL
RESECTIO
N
TREATMENT

CHEMO THERAPY
 CONTD…

CISPLASTI
N

IFOSFAMID DOXY
E CHEMOTHER RUBICIN
APY DRUGS

CYCLOPH
ETOPSIDE OSPHAMID
E
 CHONDROSARCOMA
• Occurs in cartilage
• most commonly in arm, leg, and pelvic bones
of older adults ages 50-70
 Can also arise from benign bone tumors
(osteochondromas)
 EWING’S SARCOMA

DEVELOPS IN THE
MEDULLARY CAVITY OF LONG
BONES
CONTD…

USUALLY DEVELOPS IN
CHILDREN AND TEENAGER
 METASTATIC BONE TUMOR

 The most common type of malignant bone tumor occurs as a result of

metastasis from a primary tumor located at another site.
 Common sites for the primary tumor include breast, prostate, lungs,
kidney, and thyroid.
 Metastatic cancer cells travel from the primary tumor to the bone via
the lymph and blood supply.
 The metastatic bone lesions are commonly found in vertebrae, pelvis,
femur, humerus, or ribs.
 Pathologic fractures at the site of metastasis are common because of a
weakening of the involved bone.
 High serum calcium levels result as calcium is released from damaged
bones.
 GRADING OF BONE TUMOUR
LEAST
LEAST
SEVERE
SEVERE
AND
AND
OFTEN
OFTEN
GRADE-I BENIGN
BENIGN

GRADING NO
NO
OF BONE METASTASIS
METASTASIS
TUMOUR
TUMOR
TUMOR GROWS
GROWS
SLOWLY
SLOWLY AND
AND
GRADE-II SPREAD
SPREAD TO
TO
NEARBY
NEARBY
TISSUE
TISSUE
 CONTD…

GRADI
NG

GRADE- GRADE-
III IV

TUMOUR TUMOUR TUMOUR

GROWS CELLS GROWS
QUICKLY LOOKS QUICKLY
AND VERY
SPREAD DIFFEREN
TO NEAR T FROM
BY NORMAL
CELLS AAND SPRED
TISSUES
TO DISTTANT
ARES
 ETIOLOGY

GENETIC
DEFECT
[LI RADIATION INJURY
FRAUMENI,ROT
HMUND
SYNDROME]

RETINOBLASTOM
PAGETS DISEASE
A
PATHOPHYSIOLOGY
Metastatic tumor of primary bone malignancy

non-osseous origin

Tumor grows faster than Malignant cells within bone appear foreign

Periosteum can accommodate to the immune cells at the site of invasion,

triggering inflammation

Interrupted formation of new local immune cells, release inflammatory

Periosteum around the tumor cytokines, IL, and growth factors

The inflammatory chemical milieu increase in growth factor

Stimulates different bone cell types around bone tumor

 CONTD…
Interrupted periosteal reaction

Osteoblast Osteoclast Soft tissue mass

accumulation

stimulate bone mineralization secrets acid through H pumps and

produce lysosomal hydrolases

bone destruction

Osteoclast activity> osteoblastic activity at the site of the tumor

 CLINICAL MANIFESTATION

 Cardinal symptoms include

 Pain- initially occur intermittently and only ay rest, become
more intense , disturb sleep at night, spread in to adjacent
joint, further intensification experienced as persistent and
piercing pain
 Swelling – cause skin changes including tensed shining
skin with prominent veins, hyperthermia
 General discomfort
 CONTD…
 Bone fractures, especially from slight injury
(trauma)
 Occasionally a mass and swelling can be felt at the
tumor site
 Limited mobility- occasionally it is not the tumor
but synovitis in the joint, especially in
chondroblastoma
 CONTD…
Other symptoms include
Fever, night sweats
Painless mass
Varying degree of disability, weight
loss, and malaise
 With spinal cord compression due to
spinal cord metastasis include
Neurological deficit
DIAGNOSTIC FINDINGS

BONE SCAN BIOPSY

BONE X-RAY PET SCAN

CHEST X-RAY CT SCAN

MRI

BLOOD TEST-ALKALINE
BLOOD PHOSPHATE
LEVELAND CALCIUM LEVEL
CONTD…

EPIPHYS
EAL
LESION

DIFFERE
FIBROX DIAPHY
NTAL
ANTHO SEAL
MA DIAGNOS LESION
IS

PRIMARY
INTRAOSSEOUS
HEMANGIOMA
 MANAGEMENT

CHEMO
THERAP
Y

RADIATI
OTHER
ON
TREATM
THERAP
ENT MANAG Y
EMENT

TARGET SURGIC
ED AL
THERAP MANAG
Y EMENT
 CHEMOTHERAPY

DOXY
RUBICIN
CISPLASTI
N

CHEMOT
HERAPY
DRUGS
CARBOPL
ASTIN
METHOTR
EXATE
 AMPUTATION

RECONSTUCTIVE
CURETTAGE
SURGERY

SURGIC
AL
CRYO
SURGERY
MANAG LIMD SALVAGE
EMENT
 NURSING DIAGNOSIS
 Acute pain related t compression of nerve tissue as
evidenced by facial grimacing
 Altered nutrition related to chemotherapy as
evidenced by generalized weakness
 Fatigue related to altered body chemistry as
evidenced by inability to do ADLs
 Risk for infection related to immunosuppression
MUSCULAR
DYSTROPHY
 DEFINITION

Muscular dystrophy (MD) is a group of genetic diseases characterized by

progressive symmetric wasting of skeletal muscles without evidence of
neurologic involvement.

According to Lewis
It is a group of disorders characterized by muscle weakness

According to Brunner
TYPES
 ETIOLOGY
Exact etiology is unknown
Genetic- that runs in families
 It usually develops after inheriting a faulty gene from one or
both parents\
 Depending on the specific type MD can be
 Recessive inherited disorder
 Dominant inherited disorder
 Sex linked disorder
 PATHOPHYSIOLOGY

In Duchenne and Becker MD there is a mutation of the

dystrophin gene

Dystrophin in normal muscle cells helps skeletal muscle

fibers attach to the basement membrane.

Abnormal dystrophin can lead to defects in the plasma

membrane of muscle fiber with subsequent muscle fiber
degeneration.
 CLINICAL
MANIFESTAT
ION

STAGE-I

CREATINE CLUMCY AND

MUSCULAR
KINASE WADDLING
WEAKNESS
ELEVATED GAIT
 CONTD…

STAGE-II

EARLY
AMBULATOR
Y

PROGRESSIVE POSSIBLE TOE

GOWERS SIGN
WEAKNESS IN WALKING
THE PROXIMAL
MUSCULATURE
 CONTD…

STAGE -III

DIFFICULIT IN
WALKING

RESPIRATORY CANNOT ARISE NOCTURAL

MUSCLE FROM THE
STRENGTH FLOOR HYPOXEMIA
BEGINS TO
SLOW
 .NON AMBULATORY
STAGE -IV
.POSSIBLE
DEVELOPMENT OF
SCOLIOSIS

.NON AMBULATORY
.SCOLIOSIS MAY
STAGE -V PROGRESS
.TERMINAL RESPIRATORY
OR CARDIAC FAILURE
.CONTRACTURES MAY
DEVELOP
DIAGNOSTIC EVALUATION

ELECTROCARDIOGRAM
MUSCLE FIBER BIOPSY
HISTORY
ELEVTROMYO
COLLEC
GRAM
TION,PH
YSICAL
EXAMINA
TION
 MANAGEMENT

PHYSICAL ORTHOPEDIC
THERAPY APPLIANCES

CONTINUOUS
POSITIVE
TRACHEOSTOMY
AIRWAY
PRESSURE

MECHANICAL
VENTILATOR
 NURSING MANAGEMENT

 Encourage communication among family members

(and parents) to cope with the emotional and
physical strains of MD.
 Teach the patient and caregiver range-of-motion
exercises, nutritional therapy, and signs of
progression.
 Genetic testing and counseling may be
recommended for individuals with a family history
of MD.
THANK
YOU