Infection in Bone and Joint

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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
• boysgt 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 OsteomyelitisOrganism

• Gram ve
• staphylococus aureus
• strep pyogen
• strep pneumonie
• Gram -ve
• haemophilus influnzae (50 lt 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 Osteomyelitis Infant

• failure to thrive
• drowsy
• irritable
• metaphyseal tenderness
• decrease ROM
• commonest around the knee

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Acute OsteomyelitisAdult

• 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 OsteomyelitisClinical features

• long history (weeks, months)
• pain, limp
• swelling occasionally
• local tenderness

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Subacute OsteomyelitisPathology

• Brodies abscess
• a well defined cavity
• in cancellous bone

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Subacute OsteomyelitisInvestigation

• X ray
• Bone scan
• Biopsy(50) grow organism

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Subacute OsteomyelitisTreatment

• 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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Chronic Osteomyelitis Organism

• usually mixed infection
• mostly staph. Aureus E. Coli . Strep Pyogen,
  Proteus

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Chronic Osteomyelitis Pathology

• cavities
• dead bone
• cloacae
• involucrum
• histological picture is one of chronic
  inflammation

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Chronic Osteomyelitis
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Chronic OsteomyelitisSequestrum
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Acute Septic ArthritisRoute of Infection

• direct invasion penetrating wound
• intra articular
  inj
• arthroscopy
• eruption of bone abscess
• haematogenous

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Acute Septic Arthritis Organism

• staphylococus aureus
• haemophilus influenzae
• streptococcus pyogenes
• escherishae coli

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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.

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Acute Septic Arthritis Sequelae

• complete recovery
• partial loss of the articular cartilage
• fibrous or bony ankylosis

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Acute Septic Arthritis Neonate

• Picture of Septicemia
• irritability
• resistant to movement

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Acute Septic Arthritis Child

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

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Acute Septic Arthritis Adult

• often involve superficial joint (knee, ankle,
  wrist)
• investigation
• fbc, wbc, esr crp ,blood culture
• x ray
• ultrasound
• aspiration

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Acute Septic Arthritis Differential Diagnosis

• acute osteomyelitis
• trauma
• irritable joint
• hemophilia
• rheumatic fever
• gout
• Gaucher disease

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Acute Septic Arthritis 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 tumour are
  secondary metastasis
• second most common malignant bone tumours are
  haematogenous
• primary malignant tumours are rare

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Metastatic Bone Tumours

• breast
• bronchus
• kidney
• prostate
• thyroid
• GI

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Haematogenous Bone Tumours

• 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

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Benign Bone Tumours chondromata
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Malignant Bone Tumours

• osteosarcoma
• Ewings sarcoma
• chondrosarcoma

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Bone Tumours Clinical Presentation

• asymptomatic
• pain
• swelling
• history of trauma
• neurological symptoms
• pathological fracture

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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?

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Bone Tumours Differential Diagnosis

• haematoma
• infection
• stress fracture
• myositis ossificans
• gout

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Bone Tumours Treatment

• chemotherapy
• radiotherapy
• tumour excision
• limb salvage surgery
• amputation

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TuberculosisBone And Joint

• vertebral body
• large joints
• multiple lesions in 1/3 of patient

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TuberculosisClinical Features

• contact with TB
• pain, swelling, loss of weight
• joint swelling
• decrease ROM
• ankylosis
• deformity

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TuberculosisPathology

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

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TuberculosisSpinal

• little pain
• present with abscess or kyphosis

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TuberculosisDiagnosis

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

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TuberculosisInvestigation

• FBC , ESR,
• Mantoux
• Xray soft tissue swelling
• periarticular osteoporosis
• joint appear washed out articular
  space narrowing
• Joint aspiration AAFB identified in 10-20
• culture ve in 50 of cases

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Tuberculosisdifferential diagnosis

• transient synovitis
• monoarticular ra
• haemorhagic arthritis
• pyogenic arthritis

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TuberculosisTreatment

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