Chronic Recurrent Multifocal Osteomyelitis (CRMO)

-

  • Chronic Recurrent Multifocal Osteomyelitis (CRMO) affects predominantly children and adolescents, with a peak age of onset of 10 years and a female preponderance.
  • CRMO is characterized by recurrent inflammation at multiple skeletal sites, most commonly involving the tibia, femur, clavicle, foot, or vertebral body and rarely the pelvis or rib cage.
  • Associated inflammatory disorders, includes
  • → Palmoplantar pustulosis
  • → Chronic arthritis
  • → Psoriasis
  • → Inflammatory bowel disease
  • → Pyoderma gangrenosum 
  • → Sweet's syndrome, and 
  • → Severe acne.

Clinical Features

→ Multiple episodes of localized redness, pain, & swelling of insidious onset & spontaneous regression.
→ Minimal functional impairment during the episodes.

Pathophysiology

  • The pathogenesis of this condition remains unexplained.
  • Theories include an autoimmune process or an infection from an as yet unrecognized causative agent (such as Mycoplasma, Chlamydia, atypical mycobacterium, or virus).
  • Histopathologic examination of lesions may show changes suggestive or diagnostic of osteomyelitis, with numerous neutrophils, bone necrosis, granuloma, and fibrosis with round cell infiltration.

Evaluation


• The diagnosis of CRMO is essentially one of exclusion.


Diagnostic Criteria includes-



(1) Protracted clinical course of > 3 months' duration

(2) Open biopsy results consistent with chronic inflammation, and 
(3) Failure to identify any infectious organism by culture.


  • The initial evaluation of CRMO should include the same laboratory and radiographic studies performed for any suspected infection.

  • Microbiologic tests of blood and tissue cultures should not be omitted.
  • Plain radiographs of each symptomatic area should be obtained and supplemented by bone scintigraphy, because asymptomatic lesions are occasionally identified in this manner.

Treatment

  • There is No well-defined treatment for CRMO, although most children are treated with NSAIDs and occasionally corticosteroids.
  • Effective treatment with interferon gamma has been reported in one case, and it is hoped that this method may help circumvent the prolonged, relapsing nature of CRMO.

Complications

  • CRMO is often described as a self-limiting condition of childhood that follows a benign, protracted course without sequelae.
  • An early diagnosis can avoid complications associated with unnecessary surgical or antibiotic treatment. 

Comments

  1. Unknown17 August 2017 at 16:04

    Its a very nice for orthopaedic resident n consultants

    ReplyDelete

Post a Comment

Popular posts from this blog

Hanging Cast

-
Image
Indications 1.      For displace fracture of the humeral shaft with shortening, and also for oblique and spiral fractures –(Caldwell, 1933)  2.      Used for comminuted humeral fracture, distal humeral shaft fracture. ·       Cast must be lightweight and must extend from at least 1 inch proximal to the fracture site to wrist, with elbow at right angle & forearm in neutral rotation. ·        Arm must lie dependent to provide a traction force. ·        Patient must sleep erect or semi-erect to avoid supporting elbow when seated. ·        Erect position is maintained during the day as much as possible. ·     There should be no support under the elbow, and nothing should compress the arm against the body (such as clothing). It is frequently exchanged for functional bracing 1 to 2 weeks after injury. Correction Of Angulation: 1.      Sling must be securely fixed at the wrist by a loop made of plaster or other material.      To c
Read more

SOMI Brace

-
Image
Sternal-Occipital-Mandibular Immobiliser  (SOMI) Brace  Cervico-Thoracic Orthoses (CTOs) provide greater motion restriction from C5-C7 spine from the increased leverage on the person’s body. The upper cervical spine has less motion restriction. CTOs are used in minimally unstable fractures . All CTO’s tend to control flexion better than extension . Parts 1. The SOMI is a rigid, 3-poster CTO that has an padded anterior chest plate extending to the xiphoid process, as well as two padded shoulder extension which hook over tops of the shoulder. 2. From these shoulder extension two Straps which cross in the interscapular region, pass downward and around the chest wall to attach to the lower part of the chest plate. 3. There are three adjustable uprights , which pass upward from the chest plate, two to the padded occipital support and one to the mandibular support. 4. A removable chin piece attaches to the chest plate with
Read more

Skeletal Traction: Common sites

-
Image
1. Olecranon Site: 1.25 inches (3 cm) distal to the tip of olecranon just deep to the subcutaneous border of upper end of the ulna. Direction:  Medial to lateral at right angles to the longitudinal axis of ulna. Avoid: Ulnar nerve injury. 2. Second & Third Metacarpals Site:  About 1 inch (2-2.5 cm) Proximal to the distal end of Second metacarpal Direction:  The wire traverses 2nd and 3rd metacarpals transversely at right angles to the longitudinal axis of the radius. 3. Greater trochanter (upper end of femur ) Site: On the latera
Read more