student bone & joint infections & tumours ortho

8/13/2019 Student Bone & Joint Infections & Tumours Ortho

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Infection in Bone and Joint


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Infection in bone

Osteomyelitis

acute (subacute) chronic

specific (eg TB) non specific(most common)


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Acute haematogenous OM

mostly children

boys> girls

history of trauma


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Acute Osteomyelitis

Source Of Infection

infected umbilical cord in infants

boils, tonsilitis, skin abrasions

in adults UTI, in dwelling arterial line


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Acute Osteomyelitis

Organism

Gram +ve staphylococus aureus

strep pyogen

strep pneumonie

Gram -ve haemophilus influnzae (50% < 4 y)

e .coli pseudomonas auroginosa,

proteus mirabilis


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Acute Osteomyelitis

Pathology

starts at metaphysis

?trauma

vascular stasis acute inflammation

suppuration

necrosis new bone formation

resolution


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Acute Osteomyelitis


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Acute Osteomyelitis


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Acute Osteomyelitis

Clinical Features

severe pain

reluctant to move

fever

malaise

toxemia


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Acute OsteomyelitisInfant

failure to thrive

drowsy

irritable

metaphyseal tenderness

decrease ROM

commonest around the knee


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Acute Osteomyelitis

Adult

commonly thoracolumbar spine

fever

backache

history of UTI or urological procedure

old ,diabetic ,immunocompromised


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Acute Osteomyelitis

Diagnosis

History and clinical examination

FBC, ESR, B.C.

X-ray (normal in the first (10-14) days

Ultrasound

Bone Scan Tc 99, Gallium 67

MRI

Aspiration


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Acute Osteomyelitis


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Acute Osteomyelitis

Differential Diagnosis

cellulitis

acute septic arthritis

acute rheumatism

sickle cell crisis

Gauchers disease


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Acute Osteomyelitis

Treatment

supportive treatment for pain and

dehydration splintage

antibiotics

surgery


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Acute Osteomyelitis

Complications

septicemia

metastatic infection

septic arthritis

altered bone growth

chronic osteomyelitis


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Subacute Osteomyelitis

Clinical features

long history (weeks, months)

pain, limp

swelling occasionally

local tenderness


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Pathology

Brodies abscess

a well defined cavity

in cancellous bone


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Investigation

X ray

Bone scan

Biopsy(50%) grow organism


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Treatment

antibiotics for 6 months

surgery


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Other types of OM

Sclerosing OM (non suppurative OM)

Post-operative early (within 3 months)

late


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Chronic Osteomyelitis

May follow acute OM

May start De Novo

following operation

following open #


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Organism

usually mixed infection

mostly staph. Aureus E. Coli . StrepPyogen, Proteus


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Pathology

cavities

dead bone

cloacae

involucrum

histological picture is one of chronicinflammation


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Sequestrum


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Acute Septic Arthritis

Route of Infection

direct invasion penetrating wound

intra articular inj

arthroscopy

eruption of bone abscess

haematogenous


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Organism

staphylococus aureus

haemophilus influenzae

streptococcus pyogenes

escherishae coli


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Pathology

acute synovitis with purulent joint effusion

articular cartilage attacked by bacterialtoxin and cellular enzyme

complete destruction of the articularcartilage.

A t S ti A th iti


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Sequelae

complete recovery

partial loss of the articular cartilage

fibrous or bony ankylosis


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Neonate

Picture of Septicemia

irritability

resistant to movement

A t S ti A th iti


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Child

Acute pain in single large joint

reluctant to move the joint

increase temp. and pulse

increase tenderness

A t S ti A th iti


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Adult

often involve superficial joint (knee, ankle,wrist)

investigation fbc, wbc, esr crp ,blood culture

x ray ultrasound

aspiration


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acute osteomyelitis

trauma

irritable joint

hemophilia

rheumatic fever

gout

Gaucher disease


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Treatment

general supportive measures

antibiotics

surgical drainage


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Tumour And Tumour Like

Conditions of Bone

benign tumours are common

the most common malignant bone tumourare secondary metastasis

second most common malignant bonetumours are haematogenous

primary malignant tumours are rare


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Metastatic Bone Tumours

breast

bronchus

kidney

prostate

thyroid

GI

H t


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Haematogenous oneTumours

plasmacytoma

multiple myeloma

eosinophilic granuloma

lymphoma

leukaemia


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Bone Cysts

simple bone cyst

fibrous dysplasia

aneurysmal bone cyst


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Benign Bone Tumours

osteoma

osteoid osteoma

osteochondroma

enchondroma

Benign Bone Tumours


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Benign Bone Tumours

chondromata


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Malignant Bone Tumours

osteosarcoma

Ewings sarcoma

chondrosarcoma

B T


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Bone Tumours

Clinical Presentation

asymptomatic

pain

swelling history of trauma

neurological symptoms

pathological fracture

B T


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Bone Tumours

Imaging

solitary or multiple lesions?

what type of bone is involved?

which part of the bone is involved? are the margins of the lesion well defined?

is there bony reaction?

does the lesion contain calcification?

B T


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Bone Tumours


haematoma

infection stress fracture

myositis ossificans

gout

Bone Tumours


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Bone Tumours

Treatment

chemotherapy

radiotherapy

tumour excision

limb salvage surgery

amputation

T b l i


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Tuberculosis

Bone And Joint

vertebral body

large joints

multiple lesions in 1/3 of patient


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Tuberculosis


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Tuberculosis

Pathology

primary complex ( in the lung or the gut)

secondary spread

tuberculous granuloma

Tuberculosis


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Tuberculosis

Spinal

little pain

present with abscess or kyphosis

Tuberculosis


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Tuberculosis

Diagnosis

long history

involvement of single joint marked thickening of the synovium

marked muscle wasting

periarticular osteoporosis

+ve Mantoux test


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Tuberculosis


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Tuberculosis

differential diagnosis

transient synovitis

monoarticular ra haemorhagic arthritis

pyogenic arthritis

Tuberculosis


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Tuberculosis

Treatment

chemotherapy

rifampicin

isoniazid 8 weeksethambutol

rifampicin and isoniazid 6-12 month

rest and splintage

operative drainage rarely necessary

student bone & joint infections & tumours ortho

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