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  • 1. BONE AND JOINT INFECTION Dr.Syed Alam Zeb Orthopaedic Unit HMC
  • 2. AETIOLOGY
    • Staphylococcus aureus is overall the most common.
    • Beta haemolytic streptococci and anaerobes may cause acute infection.
    • E-coli and B. streptococci are more common in children.
    • Aerobic gram negative rods may cause infection in the elderly.
  • 3. PATHOGENESIS OF BONE AND JOINT INFECTION
    • Healthy bone is resistant to infection.
    • Open fractures provide an ideal focus for infection.
    • Organisms can lie latent in dead bone(sequestrum).
    • Involucrum is healthy new bone formed in a shell around dead and infected bone.
  • 4. ACUTE SEPTIC ARTHRITIS
    • The history is short with the patient generally very unwell.
    • Young children do not move the involved limb.
    • In older patients the joint is extremely painful to move.
    • The affected limb is hot and red.
    • Night and rest pain are characteristic.
  • 5. ACUTE OSTEOMYELITIS
    • Present like acute arthritis.
    • There is fever, loss of function and localized pain.
    • In young children the presentation may simply be refusal to weight bear or use a limb.
    • The affected part is hot, tender and red.
  • 6. CHRONIC OSTEOMMYELITIS
    • Usually follow an episode of acute infection or an open fracture.
    • Pain at rest especially night pain.
    • Swelling, ulcer or sinus may be present.
    • Bony tenderness is common.
    • Systemic features are minimum.
  • 7. DIABETIC FOOT OSTEOMYELITIS
    • Neuropathy, vasculopathy and high blood sugar leads to ulcer formation.
    • Bones become secondarily involved.
    • Chronic non-healing infection result in soft tissue and bony loss.
    • Control of diabetes, improving the nutritional status and regular debridements are required.
  • 8. Investigations for acute osteomyelitis and septic arthritis
    • WBC count and CRP are high, ESR may be very high.
    • Changes on plain x-rays are not visible for some time.
    • US can pick pus.
    • Isotope scans are sensitive but not specific.
  • 9. Investigations for acute osteomyelitis and septic arthritis
    • CT may show bone erosions.
    • MRI is very helpful.
    • Culture and sensitivity is invaluable.
    • Histology of infected bony tissue sometimes required.
  • 10. MANAGEMENT
  • 11. Osteomyelitis
    • In acute osteomyelitis put the patient on iv antibiotics and pain killers.
    • Early diagnosis reduces the risk of infection becomes chronic.
    • Surgery required to remove infected tissues and to obtain material for culture.
  • 12. Chronic Osteomyelitis
    • When acute infection is not treated properly it can lead to destruction of bone.
    • The combination of dead bone with pus formation and discharging sinuses on the skin is called Chronic osteomyelitis.
    • Treatment is debridement of the dead bone and soft tissues and regular cleaning.
  • 13. Septic Arthritis
    • Joints should be aspirated before treatment is started.
    • Antibiotics started empirically then changed according to the culture results.
    • Treatment should last several weeks starting with iv antibiotics.
    • If infection recurs the joint may need to be opened and any loculi washed out.
  • 14. Chronic arthritis
    • All dead and foreign tissues must be excised
    • Secure implants may be left but all suspect soft tissues must be excised.
    • Antibiotic- impregnated beads or spacer may be put in to the joint space.
    • Blood levels of antibiotic needs regular checking.