bubble_chart Overview

Sclerosing osteomyelitis, also known as Garre's disease, idiopathic cortical sclerosis, and dry osteomyelitis, is a relatively rare condition. The cause of the disease is unknown, and it is difficult to identify pathogenic bacteria. It may sometimes be related to injury. Injury leads to subperiosteal hematoma, which calcifies. This disease primarily occurs in young adults, more frequently in males than females, often in individuals with robust constitutions, such as athletes. It commonly affects long tubular bones, with the tibia being the most frequently involved site in the lower limbs.

bubble_chart Pathological Changes

This disease is a progressive, extensive, and sclerosing inflammation of the bone. The inflammatory reaction leads to widespread fibrosis within the medullary cavity, disrupting blood circulation and reducing oxygen tension in the bone. This promotes the proliferation, deposition, and calcification of subperiosteal osteoid tissue. The obstruction of Haversian canals results in reactive thickening of the periosteum, and the bone cortex undergoes spindle-shaped hyperplasia, forming a series of pathological changes. These changes are relatively localized and mild. Unlike typical suppurative osteomyelitis, it does not produce abscesses, sequestra, or fistulas. A few wounds may exhibit some pus and granulation tissue, and cultures may reveal the growth of Staphylococcus aureus.

bubble_chart Clinical Manifestations

Systemic symptoms are not obvious, and local symptoms may sometimes be absent or include inflammatory reactions such as swelling and pain. Tenderness and distending pain are often more severe at night than during the day. The disease progresses slowly and may be aggravated by trauma or other illnesses, but the joints are mostly unaffected.

X-ray examination: In the initial stage (first stage), there are no abnormal findings within the first month. Over time, diffuse thickening and sclerosis of the cortical bone may be observed, with no clear boundary from normal bone. The medullary cavity becomes narrower or occluded compared to normal, indicating hyperplasia of the intramedullary membrane and new bone formation.

bubble_chart Treatment Measures

(1) Non-surgical treatment: The therapeutic effect is extremely poor. Antibiotics, physical therapy, and Chinese medicinals for {|###|}clearing heat and removing toxin, invigorating blood and resolving stasis

can be used. (2) Decompression surgery: Drilling for drainage or grooving procedure to remove inflammatory granulation tissue in the medullary cavity, followed by antibiotic placement. The wound may heal at the {|###|}initial stage [first stage]

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bubble_chart Differentiation

(1) Sclerotic osteosarcoma occurs in adolescents, found in the metaphysis rather than the diaphysis, with radial proliferation and the presence of a Codman's triangle. Delayed treatment may lead to pulmonary metastasis.

(2) Ewing's sarcoma patients are younger, with rapid disease progression resembling acute suppurative osteomyelitis. Symptoms include high fever, chills, severe pain, and elevated serum AKP levels. X-rays show an onion-skin appearance of the cortical bone, with destruction and expansion of the medullary cavity.

(3) Osteoid osteoma presents as cortical bone hyperplasia on one side of the proximal diaphysis, with a small translucent central area forming a nidus-like appearance.

(4) Syphilitic osteitis shows positive Wassermann test results, is painless, and manifests as symmetrical multifocal bone hyperplasia.

(5) Osteitis deformans, also known as Paget's disease, commonly affects the elderly, is multifocal, and involves the lower limbs, causing bone thickening and curvature. The disease progresses slowly with mild pain and possible local low-grade fever. X-rays reveal thickened cortical bone, expanded medullary cavity, and irregular trabecular patterns. Compensatory thickening occurs on the convex side, with elevated serum AKP levels and normal blood calcium. {|104|}