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Bone and Jont, tumours and Infection
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Bone and Jont, tumours and Infection

Bone and Jont, tumours and Infection

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Bone and Jont, tumours and Infection Presentation Transcript

  • 1. Infection in Bone and Joint
  • 2. Infection in bone
    • Osteomyelitis
      • acute (subacute)
      • chronic
      • specific (eg TB)
      • non specific(most common)
  • 3. Acute haematogenous OM
    • mostly children
    • boys> girls
    • history of trauma
  • 4. Acute Osteomyelitis Source Of Infection
    • infected umbilical cord in infants
    • boils, tonsilitis, skin abrasions
    • in adults UTI, in dwelling arterial line
  • 5. Acute Osteomyelitis Organism
    • Gram +ve
        • staphylococus aureus
        • strep pyogen
        • strep pneumonie
    • Gram -ve
        • haemophilus influnzae (50% < 4 y)
        • e .coli
        • pseudomonas auroginosa,
        • proteus mirabilis
  • 6. Acute Osteomyelitis Pathology
    • starts at metaphysis
    • ?trauma
    • vascular stasis
    • acute inflammation
    • suppuration
    • necrosis
    • new bone formation
    • resolution
  • 7. Acute Osteomyelitis
  • 8. Acute Osteomyelitis
  • 9. Acute Osteomyelitis Clinical Features
    • severe pain
    • reluctant to move
    • fever
    • malaise
    • toxemia
  • 10. Acute Osteomyelitis Infant
    • failure to thrive
    • drowsy
    • irritable
    • metaphyseal tenderness
    • decrease ROM
    • commonest around the knee
  • 11. Acute Osteomyelitis Adult
    • commonly thoracolumbar spine
    • fever
    • backache
    • history of UTI or urological procedure
    • old ,diabetic ,immunocompromised
  • 12. 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
  • 13. Acute Osteomyelitis
  • 14. Acute Osteomyelitis Differential Diagnosis
    • cellulitis
    • acute septic arthritis
    • acute rheumatism
    • sickle cell crisis
    • Gaucher’s disease
  • 15. Acute Osteomyelitis Treatment
    • supportive treatment for pain and dehydration
    • splintage
    • antibiotics
    • surgery
  • 16. Acute Osteomyelitis Complications
    • septicemia
    • metastatic infection
    • septic arthritis
    • altered bone growth
    • chronic osteomyelitis
  • 17. Subacute Osteomyelitis Clinical features
    • long history (weeks, months)
    • pain, limp
    • swelling occasionally
    • local tenderness
  • 18. Subacute Osteomyelitis Pathology
    • Brodies abscess
    • a well defined cavity
    • in cancellous bone
  • 19. Subacute Osteomyelitis Investigation
    • X ray
    • Bone scan
    • Biopsy(50%) grow organism
  • 20. Subacute Osteomyelitis Treatment
    • antibiotics for 6 months
    • surgery
  • 21. Other types of OM
    • Sclerosing OM (non suppurative OM)
    • Post-operative
      • early (within 3 months)
      • late
  • 22. Chronic Osteomyelitis
    • May follow acute OM
    • May start De Novo
    • following operation
    • following open #
  • 23. Chronic Osteomyelitis Organism
    • usually mixed infection
    • mostly staph. Aureus E. Coli . Strep Pyogen, Proteus
  • 24. Chronic Osteomyelitis Pathology
    • cavities
    • dead bone
    • cloacae
    • involucrum
    • histological picture is one of chronic inflammation
  • 25. Chronic Osteomyelitis
  • 26. Chronic Osteomyelitis Sequestrum
  • 27. Acute Septic Arthritis Route of Infection
    • direct invasion penetrating wound
    • intra articular inj
    • arthroscopy
    • eruption of bone abscess
    • haematogenous
  • 28. Acute Septic Arthritis Organism
    • staphylococus aureus
    • haemophilus influenzae
    • streptococcus pyogenes
    • escherishae coli
  • 29. 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.
  • 30. Acute Septic Arthritis Sequelae
    • complete recovery
    • partial loss of the articular cartilage
    • fibrous or bony ankylosis
  • 31. Acute Septic Arthritis Neonate
    • Picture of Septicemia
          • irritability
          • resistant to movement
  • 32. Acute Septic Arthritis Child
    • Acute pain in single large joint
        • reluctant to move the joint
        • increase temp. and pulse
        • increase tenderness
  • 33. Acute Septic Arthritis Adult
    • often involve superficial joint (knee, ankle, wrist)
    • investigation
        • fbc, wbc, esr crp ,blood culture
        • x ray
        • ultrasound
        • aspiration
  • 34. Acute Septic Arthritis Differential Diagnosis
    • acute osteomyelitis
    • trauma
    • irritable joint
    • hemophilia
    • rheumatic fever
    • gout
    • Gaucher disease
  • 35. Acute Septic Arthritis Treatment
    • general supportive measures
    • antibiotics
    • surgical drainage
  • 36. 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
  • 37. Metastatic Bone Tumours
    • breast
    • bronchus
    • kidney
    • prostate
    • thyroid
    • GI
  • 38. Haematogenous Bone Tumours
    • plasmacytoma
    • multiple myeloma
    • eosinophilic granuloma
    • lymphoma
    • leukaemia
  • 39. Bone Cysts
    • simple bone cyst
    • fibrous dysplasia
    • aneurysmal bone cyst
  • 40. Benign Bone Tumours
    • osteoma
    • osteoid osteoma
    • osteochondroma
    • enchondroma
  • 41. Benign Bone Tumours chondromata
  • 42. Malignant Bone Tumours
    • osteosarcoma
    • Ewing’s sarcoma
    • chondrosarcoma
  • 43. Bone Tumours Clinical Presentation
    • asymptomatic
    • pain
    • swelling
    • history of trauma
    • neurological symptoms
    • pathological fracture
  • 44. 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?
  • 45. Bone Tumours Differential Diagnosis
    • haematoma
    • infection
    • stress fracture
    • myositis ossificans
    • gout
  • 46. Bone Tumours Treatment
      • chemotherapy
      • radiotherapy
      • tumour excision
          • limb salvage surgery
          • amputation
  • 47. Tuberculosis Bone And Joint
    • vertebral body
    • large joints
    • multiple lesions in 1/3 of patient
  • 48. Tuberculosis Clinical Features
    • contact with TB
    • pain, swelling, loss of weight
    • joint swelling
    • decrease ROM
    • ankylosis
    • deformity
  • 49. Tuberculosis Pathology
    • primary complex ( in the lung or the gut)
    • secondary spread
    • tuberculous granuloma
  • 50. Tuberculosis Spinal
    • little pain
    • present with abscess or kyphosis
  • 51. Tuberculosis Diagnosis
    • long history
    • involvement of single joint
    • marked thickening of the synovium
    • marked muscle wasting
    • periarticular osteoporosis
    • +ve Mantoux test
  • 52. 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
  • 53. Tuberculosis differential diagnosis
    • transient synovitis
    • monoarticular ra
    • haemorhagic arthritis
    • pyogenic arthritis
  • 54. Tuberculosis Treatment
    • chemotherapy
    • rifampicin
    • isoniazid 8 weeks
    • ethambutol
    • rifampicin and isoniazid 6-12 month
    • rest and splintage
    • operative drainage rarely necessary