1 / 45

Infection in Bone and Joint

Infection in Bone and Joint. Infection in bone. Osteomyelitis acute (subacute) chronic specific (eg TB) non specific(most common). Acute haematogenous OM. mostly children boys> girls history of trauma. Acute Osteomyelitis Source Of Infection. infected umbilical cord in infants

kevinmryan
Download Presentation

Infection in Bone and Joint

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Infection in Bone and Joint

  2. Infection in bone Osteomyelitis • acute (subacute) • chronic • specific (eg TB) • non specific(most common)

  3. Acute haematogenous OM • mostly children • boys> girls • history of trauma

  4. Acute Osteomyelitis Source Of Infection • infected umbilical cord in infants • boils, tonsillitis, skin abrasions • in adults UTI, arterial lines

  5. Acute OsteomyelitisOrganism • Gram +ve • staphylococus aureus • strep pyogen • strep pneumonie • Gram -ve • haemophilus influnzae (50% < 4 y) • e .coli • pseudomonas auroginosa, • proteus mirabilis

  6. Acute Osteomyelitis Pathology • starts at metaphysis • ?trauma • vascular stasis • acute inflammation • suppuration • necrosis • new bone formation • resolution

  7. Acute Osteomyelitis

  8. Acute Osteomyelitis

  9. Acute OsteomyelitisClinical Features • severe pain • reluctant to move • fever • malaise • toxemia

  10. Acute OsteomyelitisInfant • failure to thrive • drowsy • irritable • metaphyseal tenderness • decrease ROM • commonest around the knee

  11. Acute OsteomyelitisAdult • commonly thoracolumbar spine • fever • backache • history of UTI or urological procedure • old ,diabetic ,immunocompromised

  12. Acute OsteomyelitisDiagnosis • History and clinical examination • CRP, ESR, B.C. • X-ray (normal in the first (10-14) days • Ultrasound • Bone Scan Tc 99, Gallium 67 • MRI • Aspiration

  13. Acute Osteomyelitis

  14. Acute Osteomyelitis Differential Diagnosis • cellulitis • acute septic arthritis • acute rheumatism • sickle cell crisis • Gaucher’s disease

  15. Acute OsteomyelitisTreatment • supportive treatment for pain and dehydration • splintage • antibiotics • surgery

  16. Acute Osteomyelitis Complications • septicemia • metastatic infection • septic arthritis • altered bone growth • chronic osteomyelitis

  17. Subacute OsteomyelitisClinical features • long history (weeks, months) • pain, limp • swelling occasionally • local tenderness

  18. Subacute OsteomyelitisPathology Brodies abscess a well defined cavity in cancellous bone

  19. Subacute OsteomyelitisInvestigation • X ray • Bone scan • Biopsy(50%) grow organism

  20. Subacute OsteomyelitisTreatment • antibiotics for 6 months • surgery

  21. Other types of OM • Sclerosing OM (non suppurative OM) • Post-operative • early (within 3 months) • late

  22. Chronic Osteomyelitis • May follow acute OM • May start De Novo following operation following open #

  23. Chronic Osteomyelitis Organism • usually mixed infection • mostly staph. Aureus E. Coli . Strep Pyogen, Proteus

  24. Chronic Osteomyelitis Pathology • cavities • dead bone • cloacae • involucrum • histological picture is one of chronic inflammation

  25. Chronic Osteomyelitis

  26. Chronic OsteomyelitisSequestrum

  27. Treatment • 1-antibiotics • 2-surgery; sequestrectomy, muscle flap, double lumen tube,ilazrov.

  28. Acute Septic ArthritisRoute of Infection • direct invasion penetrating wound intra articular inj arthroscopy • eruption of bone abscess • haematogenous

  29. Acute Septic Arthritis Organism • staphylococus aureus • haemophilus influenzae • streptococcus pyogenes • escherishae coli

  30. Acute Septic Arthritis Pathology • acute synovitis with purulent joint effusion • articular cartilage attacked by bacterial toxin and cellular enzyme • complete destruction of the articular cartilage.

  31. Acute Septic Arthritis Sequelae • complete recovery • partial loss of the articular cartilage • fibrous or bony ankylosis

  32. Acute Septic Arthritis Neonate Picture of Septicemia • irritability • resistant to movement

  33. Acute Septic ArthritisChild Acute pain in single large joint • reluctant to move the joint • increase temp. and pulse • increase tenderness

  34. Acute Septic Arthritis Adult • often involve superficial joint (knee, ankle, wrist) • investigation • BC, WBC, ESR, CRP ,blood culture • x ray • ultrasound • aspiration

  35. Acute Septic Arthritis Differential Diagnosis • acute osteomyelitis • trauma • irritable joint • hemophilia • rheumatic fever • gout • Gaucher disease

  36. Acute Septic Arthritis Treatment • general supportive measures • antibiotics • surgical drainage

  37. TuberculosisBone And Joint • vertebral body • large joints • multiple lesions in 1/3 of patient

  38. TuberculosisClinical Features • contact with TB • pain, swelling, loss of weight • joint swelling • decrease ROM • ankylosis • deformity

  39. TuberculosisPathology • primary complex ( in the lung or the gut) • secondary spread • tuberculous granuloma

  40. TuberculosisSpinal • little pain • present with abscess or kyphosis

  41. TuberculosisDiagnosis • long history • involvement of single joint • marked thickening of the synovium • marked muscle wasting • periarticular osteoporosis • +ve Mantoux test

  42. TuberculosisInvestigation • ESR, • Mantoux skin test. • Xray soft tissue swelling periarticular osteoporosiarticular space narrowing • Joint aspiration AAFB identified in 10-20% culture +ve in 50% of cases

  43. Tuberculosisdifferential diagnosis • transient synovitis • monoarticular ra • haemorhagic arthritis • pyogenic arthritis

  44. TuberculosisTreatment • chemotherapy rifampicin isoniazid 8 weeks ethambutol rifampicin and isoniazid 6-12 month • rest and splintage • operative drainage rarely necessary

More Related