Infection in Bone and Joint

Infection in bone Osteomyelitis acute (subacute) chronic specific (eg TB) non specific(most common)

Osteomyelitis

acute (subacute)

chronic

specific (eg TB)

non specific(most common)

Acute haematogenous OM mostly children boys> girls history of trauma

mostly children

boys> girls

history of trauma

Acute Osteomyelitis Source Of Infection infected umbilical cord in infants boils, tonsilitis, skin abrasions in adults UTI, in dwelling arterial line

infected umbilical cord in infants

boils, tonsilitis, skin abrasions

in adults UTI, in dwelling arterial line

Acute Osteomyelitis Organism Gram +ve staphylococus aureus strep pyogen strep pneumonie Gram -ve haemophilus influnzae (50% < 4 y) e .coli pseudomonas auroginosa, proteus mirabilis

Gram +ve

staphylococus aureus

strep pyogen

strep pneumonie

Gram -ve

haemophilus influnzae (50% < 4 y)

e .coli

pseudomonas auroginosa,

proteus mirabilis

Acute Osteomyelitis Pathology starts at metaphysis ?trauma vascular stasis acute inflammation suppuration necrosis new bone formation resolution

starts at metaphysis

?trauma

vascular stasis

acute inflammation

suppuration

necrosis

new bone formation

resolution

Acute Osteomyelitis

Acute Osteomyelitis

Acute Osteomyelitis Clinical Features severe pain reluctant to move fever malaise toxemia

severe pain

reluctant to move

fever

malaise

toxemia

Acute Osteomyelitis Infant failure to thrive drowsy irritable metaphyseal tenderness decrease ROM commonest around the knee

failure to thrive

drowsy

irritable

metaphyseal tenderness

decrease ROM

commonest around the knee

Acute Osteomyelitis Adult commonly thoracolumbar spine fever backache history of UTI or urological procedure old ,diabetic ,immunocompromised

commonly thoracolumbar spine

fever

backache

history of UTI or urological procedure

old ,diabetic ,immunocompromised

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

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

Acute Osteomyelitis

Acute Osteomyelitis Differential Diagnosis cellulitis acute septic arthritis acute rheumatism sickle cell crisis Gaucher’s disease

cellulitis

acute septic arthritis

acute rheumatism

sickle cell crisis

Gaucher’s disease

Acute Osteomyelitis Treatment supportive treatment for pain and dehydration splintage antibiotics surgery

supportive treatment for pain and dehydration

splintage

antibiotics

surgery

Acute Osteomyelitis Complications septicemia metastatic infection septic arthritis altered bone growth chronic osteomyelitis

septicemia

metastatic infection

septic arthritis

altered bone growth

chronic osteomyelitis

Subacute Osteomyelitis Clinical features long history (weeks, months) pain, limp swelling occasionally local tenderness

long history (weeks, months)

pain, limp

swelling occasionally

local tenderness

Subacute Osteomyelitis Pathology Brodies abscess a well defined cavity in cancellous bone

Brodies abscess

a well defined cavity

in cancellous bone

Subacute Osteomyelitis Investigation X ray Bone scan Biopsy(50%) grow organism

X ray

Bone scan

Biopsy(50%) grow organism

Subacute Osteomyelitis Treatment antibiotics for 6 months surgery

antibiotics for 6 months

surgery

Other types of OM Sclerosing OM (non suppurative OM) Post-operative early (within 3 months) late

Sclerosing OM (non suppurative OM)

Post-operative

early (within 3 months)

late

Chronic Osteomyelitis May follow acute OM May start De Novo following operation following open #

May follow acute OM

May start De Novo

following operation

following open #

Chronic Osteomyelitis Organism usually mixed infection mostly staph. Aureus E. Coli . Strep Pyogen, Proteus

usually mixed infection

mostly staph. Aureus E. Coli . Strep Pyogen, Proteus

Chronic Osteomyelitis Pathology cavities dead bone cloacae involucrum histological picture is one of chronic inflammation

cavities

dead bone

cloacae

involucrum

histological picture is one of chronic inflammation

Chronic Osteomyelitis

Chronic Osteomyelitis Sequestrum

Acute Septic Arthritis Route of Infection direct invasion penetrating wound intra articular inj arthroscopy eruption of bone abscess haematogenous

direct invasion penetrating wound

intra articular inj

arthroscopy

eruption of bone abscess

haematogenous

Acute Septic Arthritis Organism staphylococus aureus haemophilus influenzae streptococcus pyogenes escherishae coli

staphylococus aureus

haemophilus influenzae

streptococcus pyogenes

escherishae coli

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.

acute synovitis with purulent joint effusion

articular cartilage attacked by bacterial toxin and cellular enzyme

complete destruction of the articular cartilage.

Acute Septic Arthritis Sequelae complete recovery partial loss of the articular cartilage fibrous or bony ankylosis

complete recovery

partial loss of the articular cartilage

fibrous or bony ankylosis

Acute Septic Arthritis Neonate Picture of Septicemia irritability resistant to movement

Picture of Septicemia

irritability

resistant to movement

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

Acute pain in single large joint

reluctant to move the joint

increase temp. and pulse

increase tenderness

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

often involve superficial joint (knee, ankle, wrist)

investigation

fbc, wbc, esr crp ,blood culture

x ray

ultrasound

aspiration

Acute Septic Arthritis Differential Diagnosis acute osteomyelitis trauma irritable joint hemophilia rheumatic fever gout Gaucher disease

acute osteomyelitis

trauma

irritable joint

hemophilia

rheumatic fever

gout

Gaucher disease

Acute Septic Arthritis Treatment general supportive measures antibiotics surgical drainage

general supportive measures

antibiotics

surgical drainage

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

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

Metastatic Bone Tumours breast bronchus kidney prostate thyroid GI

breast

bronchus

kidney

prostate

thyroid

GI

Haematogenous Bone Tumours plasmacytoma multiple myeloma eosinophilic granuloma lymphoma leukaemia

plasmacytoma

multiple myeloma

eosinophilic granuloma

lymphoma

leukaemia

Bone Cysts simple bone cyst fibrous dysplasia aneurysmal bone cyst

simple bone cyst

fibrous dysplasia

aneurysmal bone cyst

Benign Bone Tumours osteoma osteoid osteoma osteochondroma enchondroma

osteoma

osteoid osteoma

osteochondroma

enchondroma

Benign Bone Tumours chondromata

Malignant Bone Tumours osteosarcoma Ewing’s sarcoma chondrosarcoma

osteosarcoma

Ewing’s sarcoma

chondrosarcoma

Bone Tumours Clinical Presentation asymptomatic pain swelling history of trauma neurological symptoms pathological fracture

asymptomatic

pain

swelling

history of trauma

neurological symptoms

pathological fracture

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?

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?

Bone Tumours Differential Diagnosis haematoma infection stress fracture myositis ossificans gout

haematoma

infection

stress fracture

myositis ossificans

gout

Bone Tumours Treatment chemotherapy radiotherapy tumour excision limb salvage surgery amputation

chemotherapy

radiotherapy

tumour excision

limb salvage surgery

amputation

Tuberculosis Bone And Joint vertebral body large joints multiple lesions in 1/3 of patient

vertebral body

large joints

multiple lesions in 1/3 of patient

Tuberculosis Clinical Features contact with TB pain, swelling, loss of weight joint swelling decrease ROM ankylosis deformity

contact with TB

pain, swelling, loss of weight

joint swelling

decrease ROM

ankylosis

deformity

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

primary complex ( in the lung or the gut)

secondary spread

tuberculous granuloma

Tuberculosis Spinal little pain present with abscess or kyphosis

little pain

present with abscess or kyphosis

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

long history

involvement of single joint

marked thickening of the synovium

marked muscle wasting

periarticular osteoporosis

+ve Mantoux test

Tuberculosis Investigation 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

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

Tuberculosis differential diagnosis transient synovitis monoarticular ra haemorhagic arthritis pyogenic arthritis

transient synovitis

monoarticular ra

haemorhagic arthritis

pyogenic arthritis

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

chemotherapy

rifampicin

isoniazid 8 weeks

ethambutol

rifampicin and isoniazid 6-12 month

rest and splintage

operative drainage rarely necessary