INFECTIONS OF THE BONES & JOINTS

DR.S.BRANAVAN CONSULTANT SURGEON TH BATTICALOA

OSTEOMYELITIS
Suppurative process of the bone Can be Acute or Chronic ACUTE OSTEOMYELITIS Commonly in children If adults are affected its due to immuno compromization Usually a haematogenous spread Mostly affects the metaphysis / joint involvement is rare

Pathogens Staphylococcus aureas -60-85% Streptococcus haemolyticus Salmonella in Sickle cell disease patients Pseudomonas Clostridium H.influenza between 7/12 and 4 years of life Pathophysiology abscess forms in metaphysis if no antibiotic treatment is commenced

CLINICAL FEATURES Fever, swelling, limitation of movements tachycardia, dehydration, extreme tenderness

DD- Septic arthritis, cellulitis INVESTIGATIONS Elevated WCC Blood cultures are positive in 60% X rays Essentially normal for 10 days >2/52 shows Sequestrum- dense dead bone Involucrum reactive new bone formation Cloacae holes through which sequestrum is released

Bone scan ( Tc99, GA 67) Confirms diagnosis early as 24-48 hrs. But it cannot differentiate infection from tumour TREATMENT Rest / elevation of the limb IV fluids IV antibiotics initially cloxacillin & fuscidic acid Children <4 yrs cephalosporins preferred as Gram negative infections are common Then change according to ABST IV until patient clinically improves/ CRP improves(usually 1-2 wks) Then continue oral antibiotics for a total period of 4-6 weeks

Surgery If the child doesnt settle by 48 hrs or obvious abscess forms Complications Septicemia Septic arthritis -rare Chronic osteomyelitis Pathological fractures

CHRONIC OSTEOMYELITIS
Om lasting for > 3/52 Causes Sequalae of acute OM Open # Bone surgeries Chronic from the beginning eg.TB Fungal CLINICAL FEATURES Symptoms are few; acute exacerbations produce symptoms Of acute inflammation Signs Irregular thickening / sausage finger Sinuses Shortening / lengthening on limbs Pathological fractures

PATHOLOGY OF CHRONIC OSTEOMYELITIS Sequestrum Involucrum Clocae Brodies abscess localized abscess on metaphysis INVESTIGATION X rays Sinogram Tc99-HDP scan CT/MRI

TREATMENT Antibiotics which should penetrate the sclerotic bone Fuscidic acid , Clindamycin, Cephalosporins Surgery Sequestrectomy Amputations Complications Acute exacerbations Growth retardation Pathological # Deformities Amyloidosis Which type? Read Squamus cell carcinoma of the chronic sinus tract

TB OSTEOMYELITIS
Skeletal TB is always secondary primary is from lung,GIT, LN Spine is the commonest bone (Potts Disease) Dorsal > Lumbar > Cervical CLINICAL FEATURES Mono articular pain / backpain Constitutional symptoms Pathological # / Kyphosis

INVESTIGATIONS General Investigations X rays Disc & adjacent two bodies (Common blood supply) CT MRI Biopsy TREATMENT Anti TB drugs for 9/12 Surgery for pathological #, Cord compression

INFECTIVE ARTHRITIS

Pyogenic Septic arthritis Gonococcal arthritis Syphylitic arthritis

SEPTIC ARTHRITIS Acute Bacterial Infections of joints 90% are mono articular Causes S.aureas 50% Streptococcus 20% Pneumococcus Routes of Entry Haematogenous from GI,RS Pyogenic OM Penetrating wounds

PATHOLOGY Exudation into joints serous/ purulent Destruction of articular cartilage & ligaments CLINICAL FEATURES Pain usually mono articular Fever in 50% , unwell Local inflammatory signs INVESTIGATIONS General blood investigations Joint aspirate for Gram stain, culture X rays soft tissue swelling only later develop cartilage destruction and loss of joint space

Treatment
Surgical Emergency Arthrotomy and drainage Immobilize Antibiotics 4/52