1 Infection in Bone and Joint
2 Infection in bone Osteomyelitis acute (subacute) chronicspecific (eg TB) non specific(most common)
3 Acute haematogenous OMmostly children boys> girls history of trauma
4 Acute Osteomyelitis Source Of Infectioninfected umbilical cord in infants boils, tonsillitis, skin abrasions in adults UTI, arterial lines
5 Acute Osteomyelitis OrganismGram +ve staphylococus aureus strep pyogen strep pneumonie Gram -ve haemophilus influnzae (50% < 4 y) e .coli pseudomonas auroginosa, proteus mirabilis
6 Acute Osteomyelitis Pathologystarts at metaphysis ?trauma vascular stasis acute inflammation suppuration necrosis new bone formation resolution
7 Acute Osteomyelitis
8 Acute Osteomyelitis
9 Acute Osteomyelitis Clinical Featuressevere pain reluctant to move fever malaise toxemia
10 Acute Osteomyelitis Infantfailure to thrive drowsy irritable metaphyseal tenderness decrease ROM commonest around the knee
11 Acute Osteomyelitis Adultcommonly thoracolumbar spine fever backache history of UTI or urological procedure old ,diabetic ,immunocompromised
12 Acute Osteomyelitis DiagnosisHistory 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 Diagnosiscellulitis acute septic arthritis acute rheumatism sickle cell crisis Gaucher’s disease
15 Acute Osteomyelitis Treatmentsupportive treatment for pain and dehydration splintage antibiotics surgery
16 Acute Osteomyelitis Complicationssepticemia metastatic infection septic arthritis altered bone growth chronic osteomyelitis
17 Subacute Osteomyelitis Clinical featureslong history (weeks, months) pain, limp swelling occasionally local tenderness
18 Subacute Osteomyelitis PathologyBrodies abscess a well defined cavity in cancellous bone
19 Subacute Osteomyelitis InvestigationX ray Bone scan Biopsy(50%) grow organism
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21 Subacute Osteomyelitis Treatmentantibiotics for 6 months surgery
22 Other types of OM Sclerosing OM (non suppurative OM) Post-operativeearly (within 3 months) late
23 Chronic OsteomyelitisMay follow acute OM May start De Novo following operation following open #
24 Chronic Osteomyelitis Organismusually mixed infection mostly staph. Aureus E. Coli . Strep Pyogen, Proteus
25 Chronic Osteomyelitis Pathologycavities dead bone cloacae involucrum histological picture is one of chronic inflammation
26 Chronic Osteomyelitis
29 Acute Septic Arthritis Route of Infectiondirect invasion penetrating wound intra articular inj arthroscopy eruption of bone abscess haematogenous
30 Acute Septic Arthritis Organismstaphylococus aureus haemophilus influenzae streptococcus pyogenes escherishae coli
31 Acute Septic Arthritis Pathologyacute synovitis with purulent joint effusion articular cartilage attacked by bacterial toxin and cellular enzyme complete destruction of the articular cartilage.
32 Acute Septic Arthritis Sequelaecomplete recovery partial loss of the articular cartilage fibrous or bony ankylosis
33 Acute Septic Arthritis NeonatePicture of Septicemia irritability resistant to movement
34 Acute Septic Arthritis ChildAcute pain in single large joint reluctant to move the joint increase temp. and pulse increase tenderness
35 Acute Septic Arthritis Adultoften involve superficial joint (knee, ankle, wrist) investigation BC, WBC, ESR, CRP ,blood culture x ray ultrasound aspiration
36 Acute Septic Arthritis Differential Diagnosisacute osteomyelitis trauma irritable joint hemophilia rheumatic fever gout Gaucher disease
37 Acute Septic Arthritis Treatmentgeneral supportive measures antibiotics surgical drainage
38 Tuberculosis Bone And Jointvertebral body large joints multiple lesions in 1/3 of patient
39 Tuberculosis Clinical Featurescontact with TB pain, swelling, loss of weight joint swelling decrease ROM ankylosis deformity
40 Tuberculosis Pathologyprimary complex ( in the lung or the gut) secondary spread tuberculous granuloma
41 Tuberculosis Spinal little pain present with abscess or kyphosis
42 Tuberculosis Diagnosislong history involvement of single joint marked thickening of the synovium marked muscle wasting periarticular osteoporosis +ve Mantoux test
43 Tuberculosis InvestigationESR, Mantoux skin test. Xray soft tissue swelling periarticular osteoporosi articular space narrowing Joint aspiration AAFB identified in 10-20% culture +ve in 50% of cases
44 Tuberculosis differential diagnosistransient synovitis monoarticular ra haemorhagic arthritis pyogenic arthritis
45 Tuberculosis Treatmentchemotherapy rifampicin isoniazid weeks ethambutol rifampicin and isoniazid 6-12 month rest and splintage operative drainage rarely necessary