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

    + Chris  OliverChris Oliver, 3 years ago

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    Bone and Jont, tumours and Infection

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