Orthopedics - Oleksa A.P. 2006

Osteomyelitis
Garre's Sclerosing Osteomyelitis (Carl Garre)

Garre's sclerosing Osteomyelitis is a chronic inflammatory process with a mild clinical course. This condition most frequently occurs in individuals aged 20-30, occasionally in children and adolescents, and typically localizes in the diaphysis of the Tibia, Femur, and humerus.

Osteosclerotic bone inflammation (ostitis chronica diffusa scleroticans Garre) clinically manifests as mild pain in the affected area of the long tubular bone diaphysis resulting from inflammatory structural changes, without signs of acute inflammation or bone necrosis (Chapmann M., 1988; Collert S., Jacson J., 1982; Dega W., 1974; Handrick W. et al., 1991).

This induces productive processes in the periosteum and endosteum in the absence of pus formation (Van Linthoudt D., Ott H., 1991; Bouzaiene M. et al., 1995; Pape H. et al., 1995).

Class="center">Table 13. Acute osteomyelitis, Exacerbation of chronic osteomyelitis (fistulous form) associated with a decrease in the absolute count of T-lymphocytes, Th: Tc<1, and a high (>200 optical density units) circulating immune complex (CIC) level

Table 14. Chronic osteomyelitis in remission and in the presence of delayed consolidation

Pain, particularly nocturnal, can persist for a prolonged period and may be triggered by limb overload. Occasionally, mild soft tissue Swelling may occur around the site of bone inflammation, and the patient may exhibit tenderness to Palpation in this area. Low-grade local fever is sometimes observed.

Radiological examination reveals sclerotic thickening of the affected bone region with loss of normal bone architecture, a narrowed medullary canal, and periosteal reaction (Fig. 398).

The ERYTHROCYTE SEDIMENTATION RATE (ESR) is often elevated, accompanied by mild peripheral Blood leukocytosis. Alkaline phosphatase levels are occasionally increased.

Bone biopsy of the affected area demonstrates non-specific inflammation without signs of suppuration, yet with marked sclerosis.

Bacteriological cultures typically yield no Microbial growth (Collert S., 1982; Chapmann M.L., 1988; Van Linthoudt D., Ott H., 1991). However, some authors suggest that Garre's osteomyelitis may be caused by low-virulence microflora (staphylococci) against the Background of altered body reactivity.

Based on radiographic findings, chronic sclerosing osteomyelitis of Garre sometimes requires differentiation from Bone tumors, osteoid osteoma, Paget's Disease, or post-traumatic reparative processes.

Fig. 398. Chronic sclerosing osteomyelitis of Garre of the right femur.

Treatment of sclerosing osteomyelitis primarily relies on conservative management, including analgesics and broad-spectrum osteotropic Antibiotics. Performing a nasopharyngeal swab for bacteriological culture and antibiotic sensitivity testing is recommended. An autogenous vaccine is prepared from the isolated microflora, and a 15-25 day course of treatment is administered.

When the condition is chronic, localized pain persistently troubles the patient, and conservative therapy proves ineffective, surgical intervention is warranted. Most frequently, the primary approach involves drilling the pathologically altered bone using Beck's technique. The sclerotic bone is perforated with Kirschner wires in multiple sites, occasionally in a crisscross pattern.

Trepanation of the bone and creation of a cortical window down to the medullary canal can also be effective surgical Procedures (Dega W., 1974; Chapmann M., 1988; Van Linthoudt D., 1991; Bouzaiene M. et al., 1995; Pape H. et al., 1995).

Thus, the administration of osteotropic antibiotics, autogenous vaccine therapy, and fenestration of the sclerotic bone represent the most rational approach to patient management.