Bone and joint infection. Syed alam Zeb


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Bone and joint infection. Syed alam Zeb

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