1. Acute haematogenous osteomyelitis is a serious inflammatory disorder of the musculoskeletal system that mainly affects children. Staphylococcus aureus is the most common causal organism. It leads to inflammation, suppuration, and bone necrosis near the metaphysis of long bones. 2. Acute septic arthritis, also known as pyogenic arthritis, can infect joints via direct invasion, direct spread from a bone abscess, or blood spread. Common causal organisms are S. aureus, H. influenzae, and streptococcus. It leads to an acute inflammatory reaction in the synovial membrane and erosion of cartilage. 3. Treatment for both conditions involves supportive care, splinting, parenteral

1. KEGAWATAN
MUSKULOSKELETAL
NON TRAUMA
Dr. Su Djie To Rante, Sp.OT
FK UNDANA

2. ACUTE HAEMATOGENOUS
OSTEOMYELITIS
• One of the most serious inflammatory disorder of the
musculoskeletal system
• Almost invariably a disease of children
• Trauma may determine the site of infection
• Causal organism:
– Stap. Aureus (90%)
– Strep. Pyogenes
– H.influenza  under 4 yrs
• Predilection: metaphysis

3. • Pathology  varies: age, site of infection,
virulence of organism , host response
1. Inflammation
2. Suppuration
3. Necrosis
4. New Bone Formation
5. Resolution

4. infants children

8. • Clinical feature
1. Pain: severe and constant near the end of
the involved long bone
2. Fever
3. Inflammation
4. Acute tenderness
• Imaging
1. Plain: normal (10 days)
2. Ultrasound
3. Scintigraphy
4. MRI

11. • Investigation
1. WBC
2. ESR
3. Blood culture
4. Antistaphylococcal antibody titer
• Diff Diagnosis
1. Cellulitis
2. ASA
3. Acute Rheumatism

12. • Treatment:
1. Supportive: pain, dehydration- IVFD,
blood transfusion
2. Splintage or traction
3. Antibiotic parenterally -2weeks, continued
min.4 weeks
4. Surgical Drainage, if local and systemic
manifestations not improved after 24
hours

13. • Complication
1. Death from septicemia
2. Metastasis Infection
3. Abscess
4. Septic Arthritis
5. Altered Bone Growth
6. Chronic Osteomyelitis

14. • Prognosis ~
1. Time interval between onset of infection
and the institution of treatment
2. Effectiveness of antibiotic
3. Dosage of antibiotic
4. Duration

15. ACUTE SEPTIC ARTHRITIS
(PYOGENIC ARTHRITIS)
• Joint can be infected
1. Direct invasion: penetrating wound, i.a.
injection, arthroscopy
2. Direct spread: bone abscess
3. Blood spread
• Causal Organism
1. Stap.aureus
2. Haem influenza: infant
3. Streptococcus

16. • Predisposing Condition
1. RA
2. Chronic disorder
3. IV Drug Abuse
4. Immunosupressive drug theraphy
5. AIDS

17. • Pathology: haematogenous infection
(synovial membrane)acute inflammatory
reactionexudationcartilage eroded and
destroyed.
• If infection goes untreated: spread to bone,
abscess, sinuses
• Healing
1. Complete resolution
2. Partial loss of cartilage and fibrosis of
joint
3. Loss of cartilage and bony ankylosis
4. Bone destruction and permanent
deformity

19. • Clinical features
1. Newborn Infant
– Septichaemia > joint pain
– Irritable
– Fever
2. Children
– Acute pain in a single large joint
– ‘Pseudopharesis’
– Ill
– Fever

20. 3. Adult
– Superficial joint: knee, ankle, wrist
– Painful, swollen, inflamed
• Imaging
1. Plain, in early was normal
2. Ultrasound: joint effusion, widened of
joint space
• Investigation
1. WBC
2. ESR
3. Culture

28. • Diff. Diagnosis
1. Acute Osteomyelitis
2. Trauma; synovitis, haemarthrosis
3. Irritable joint
4. Haemophilic Bleed
5. Rheumatic fever
6. Gout and Pseudogout

29. • Treatment: aspirate the joint and examine the
fluid
1. Supportive
2. Splintage
3. Antibiotic
4. Drainage (arthrotomy)
5. Aftercare: reconstructive, arthrodesis

30. • Complication
1. Bone destruction
2. Cartilage destruction
3. Growth disturbance