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BONES
Normal skeletal system
 Bone is a type of connective tissue
 Inorganic component – calcuim hydroxyapatite
 Organic comp...






Bone forming cells – osteoprogenitor
cells, osteoblasts & osteocytes
Osteoblasts – uninucleate, along new bone
fo...






Osteocytes – numerous, osteoblasts which get
incorporated into bone matrix during
synthesis, found within lacunae...


Osteoblasts depositing collagen in random
weave – woven bone / orderly layered – lamellar
bone





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Cartilage lacks blood vessels, lymphatics &
nerves
2 components – cartilage matrix & chondrocytes
Cartilage m...
INFECTIONS – OSTEOMYELITIS
 Inflammation of bone & marrow
 Manifests as primary solitary focus of disease
 Systemic dis...
PYOGENIC OSTEOMYELITIS
 Bacterial infection – hematogenous route
, contiguous site , direct implantation
 Infants & youn...






E.coli, Pseudomonas, Klebsiella
Location – neonate-> metaphysis
Children – metaphysis
Adult – epiphysis
Morphology –
 Depends on stage – acute , subacute or chronic
& location of infection
 Suppuration, ischaemic necrosis, h...






Infection begins in metaphyseal end of marrow
cavity occupied by pus, microscopy shows
congestion, oedema, & exud...





May penetrate through cortex creating draining
sinus tracts
Combination of suppuration & impaired blood
supply to ...




Continued neo-osteogenesis gives rise to dense
sclerotic pattern of osteomyelitis
Occasionally acute osteomyelitis m...
Clinical course –
 Acute systemic illness with malaise , fever, chills
, leucocytosis & pain
 X – ray – lytic focus of b...
Complications
 Septicaemia
 Acute bacterial arthritis
 Pathologic #
 SCC
 Secondary amyloidosis
TUBERCULOUS OSTEOMYELITIS
 Adolescents or young adults
Morphology –
 Blood borne , originate from focus of active
infect...






Central caseous necrosis, granuloma
Involvement of joint space & interverebral disc
are frequent
Pott’s disease –...


Psoas abscess – extension of caseous material
alongwith pus from lumbar vertebrae to sheaths
of psoas muscle





Pain on motion , localized tenderness
, fever,chills & weight loss
Kyphosis & scoliotic deformities
Neurologic def...
Bones
Bones
Bones
Bones
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Bones

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Bones

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Transcript of "Bones"

  1. 1. BONES
  2. 2. Normal skeletal system  Bone is a type of connective tissue  Inorganic component – calcuim hydroxyapatite  Organic component – cells & protein of matrix
  3. 3.    Bone forming cells – osteoprogenitor cells, osteoblasts & osteocytes Osteoblasts – uninucleate, along new bone forming surfaces, synthesise bone matrix Osteoblasts surrounded by matrix - osteocytes
  4. 4.    Osteocytes – numerous, osteoblasts which get incorporated into bone matrix during synthesis, found within lacunae Osteoclasts – large multinucleate cells, bone resorption Osteiod matrix – 90-95% of type I collagen
  5. 5.  Osteoblasts depositing collagen in random weave – woven bone / orderly layered – lamellar bone
  6. 6.       Cartilage lacks blood vessels, lymphatics & nerves 2 components – cartilage matrix & chondrocytes Cartilage matrix – inorganic – hydroxyapatite Organic – 80% water, 20% type II collagen & proteoglycans Chondrocytes – primitive mesenchymal cells – chondroblasts -> chondrocytes Hyaline cartilage, fibrocartilage, elastic cartilage
  7. 7. INFECTIONS – OSTEOMYELITIS  Inflammation of bone & marrow  Manifests as primary solitary focus of disease  Systemic diseases spreading to bone – typhoid, actinomycosis, syphilis, brucellosis, myc etoma  * Pyogenic bacteria & mycobacteria
  8. 8. PYOGENIC OSTEOMYELITIS  Bacterial infection – hematogenous route , contiguous site , direct implantation  Infants & young children – 5-15 yrs  Long bones / vertebral bodies  Common – staph aureus- express receptor to bone matrix components & facilitates adherence to bone tissue
  9. 9.     E.coli, Pseudomonas, Klebsiella Location – neonate-> metaphysis Children – metaphysis Adult – epiphysis
  10. 10. Morphology –  Depends on stage – acute , subacute or chronic & location of infection  Suppuration, ischaemic necrosis, healing by fibrosis & bony repair  Acute inflammatory reaction -> cell death  Entrapped bone – necrosis  Bacteria & inflammation spreads
  11. 11.    Infection begins in metaphyseal end of marrow cavity occupied by pus, microscopy shows congestion, oedema, & exudate of neutrophils Infection spreads along marrow cavity to endosteum, haversial canal – Periosteitis May reach subperiosteal space – subperiosteal abscess
  12. 12.    May penetrate through cortex creating draining sinus tracts Combination of suppuration & impaired blood supply to cortex results in erosion, thinning & infarction necrosis of cortex – Sequestrum Later there is formation of new bone beneath periosteum present over infected bone. This forms encasing sheath around necrosed bone Involucrum
  13. 13.   Continued neo-osteogenesis gives rise to dense sclerotic pattern of osteomyelitis Occasionally acute osteomyelitis may be contained to a localised area & walled off by fibrous tissue & granulation tissue – Brodie’s abscess
  14. 14. Clinical course –  Acute systemic illness with malaise , fever, chills , leucocytosis & pain  X – ray – lytic focus of bone destruction surrounded by zone of sclerosis  Blood culture , biopsy
  15. 15. Complications  Septicaemia  Acute bacterial arthritis  Pathologic #  SCC  Secondary amyloidosis
  16. 16. TUBERCULOUS OSTEOMYELITIS  Adolescents or young adults Morphology –  Blood borne , originate from focus of active infection  Sites – spine , knees & hips
  17. 17.    Central caseous necrosis, granuloma Involvement of joint space & interverebral disc are frequent Pott’s disease – TB of spine commences in vertebral body, may be associated with compression #, destruction of intervertebral discs -> permanent damage & paraplegia
  18. 18.  Psoas abscess – extension of caseous material alongwith pus from lumbar vertebrae to sheaths of psoas muscle
  19. 19.    Pain on motion , localized tenderness , fever,chills & weight loss Kyphosis & scoliotic deformities Neurologic deficits
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