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Purulent Infection of Bone
and Joint
Li Qiang
The Second Clinical College
Hainan Medical College
Section 1
suppurative osteomyelitis
Basic concepts
Pyogenic osteomyelitis is a disease
caused by pyogenic bacteria.
suppurative
osteomyelitis
Bone tissue periosteum → bone
→ bone marrow
Classification
Route of infection
Hematogenous
Traumatic
Adjacent
infection foci
Clinical
Acute
Chronic
suppurative
osteomyelitis
Acute hematogenous osteomylitis
• Prone age
• 3-15 years old (< 10 years
• old ↑)
• Prone part
• Long tubular bone,
• metaphysis
Acute hematogenous
osteomylitis
pathogeny
• pathogenic bacteria
• Staphylococcus aureus, Streptococcus B, etc
• Disease condition
• Internal cause: decreased resistance (whole
body, local)
• External causes: strong cytotoxicity, large
number, trauma, etc
Acute
hematogenous
osteomylitis
Pathological characteristics
• Bone destruction, resorption and new bone
formation coexist.
• Early destruction and late proliferation.
Acute hematogenous
osteomylitis
Spreading route
• Bacteria reenter the blood
• Spread to subperiosteal and
soft tissue
• Spread to the long bone end
• Spread to joints
Acute hematogenous
osteomylitis
clinical manifestation
 Systemic symptoms of infection and poisoning
 Local signs: pain, fear of movement, refuse to
press
 Tenderness and high skin temperature
 Redness, swelling, heat and pain
Acute hematogenous
osteomylitis
 Laboratory examination:
 leukocytes and neutrophils
 increase
 Increased ESR
 blood culture
Acute hematogenous
osteomylitis
 Imaging examination
 X-ray
 CT
 MRI
Acute hematogenous
osteomylitis
Diagnosis
Early diagnosis: significant
basis:
History of local injury or infection elsewhere.
The high heat pulse is fast and the white blood
cell is increased.
Limb pain, fear of movement and refuse to
press.
Local puncture, smear positive.
Limb symptoms, positive blood culture.
Acute hematogenous
osteomylitis
Treatment
Acute hematogenous
osteomylitis
Whole body support
rational use
Local braking
surgical treatment
Treatment
Whole body support
Rehydration, cooling and heat
supplement in high fever
Correct acidosis
Digestible, high calorie food
If necessary, a small amount of multiple
blood transfusions
Acute hematogenous
osteomylitis
Rational administration of
drug
Antibiotic application
Principle: early and
sufficient sensitivity
Joint whole course
Methods: Empirical
medication
Guiding medication
Acute hematogenous
osteomylitis
Local braking
Objective: to relieve spasm and
pain
Prevent joint contracture and
deformity shape
Prevent pathological fracture
Method: gypsum / brace
Acute hematogenous
osteomylitis
Surgical treatment
Indication: local + poisoning symptoms
Conservative treatment for 48-72h was
ineffective
Objective: decompression + drainage
Timing: once determined, implement as
soon as possible
Methods: drilling decompression
Fenestration and drainage
Acute hematogenous
osteomylitis
Acute hematogenous
osteomylitis
Turn
• recovery
• chronic
• death
Acute hematogenous
osteomylitis
Typical case
Osteomyelitis
Typical case Osteomyelitis
Chronic osteomylitis
Pathological characteristics
• Recurrent local
inflammation
• Sinus
• Dead cavity
• Dead bone
• Neoosteogenesis
Chronic
osteomylitis
Clinical manifestation
 The disease may be asymptomatic at the
inactive stage
 The bone loses its original shape, and the
limbs can be thickened and deformed
 Skin discoloration, multiple scars, ulcer
formation
 Sinus formation, granulation tissue protrusion,
and outflow of foul smelling pus
 Deformity of adjacent joints caused by muscle
twinning
Chronic
osteomylitis
Clinical manifestation
 Acute stage: local tenderness, high skin
temperature, redness, swelling and heat
pain
 Toxic blood symptom
 Sinus ostium is open and dead bone is
discharged
 Course: recurrent attacks
 The acute attack may occur once every
few months or years
Chronic
osteomylitis
Diagnosis
• Recurrent
attacks
• Local features
• X-ray findings
Chronic
osteomylitis
Treatment
Treatment principle: surgical
treatment
Objective: to clear the focus and
remove the dead bone
Eliminate dead space and remove
sinus tract
Improve blood circulation and repair
wound
Chronic
osteomylitis
Surgical indication
• Dead bone, dead cavity, sinus
• Local scars often break
• Local soft tissue defect and bone
exposure
Chronic
osteomylitis
Timing of operation:
Paroxysmal interval
Antibiotic application
Formation of new bone shell
Chronic
osteomylitis
Surgical method
Focal clearance + lavage
Operation to eliminate dead
space
-Muscle flap packing
-Cancellous bone filling
-Bone cement filling
-Vascularized bone graft
Chronic
osteomylitis
Surgical method
• Orr operation
• Excision of diseased bone
• Amputation
Chronic
osteomylitis
Typical case
Typical case
Section 2
Suppurative Arthritis
Concept
Septic arthritis: septic infection in
joints caused by septic bacteria.
Common in children; The knee joint
and hip joint are the prone sites.
suppurative
arthritis
pathogeny
• Pathogenic bacteria: Staphylococcus
aureus, hemolytic streptococcus, etc
• Infection condition
• Route of infection: hematogenous
• traumatic
• the tendency to spread
• Iatrogenic
suppurative
arthritis
Pathological process
• Slurry exudation period (complete recovery)
• Cellulosic exudation stage of slurry (partial
recovery)
• Purulent exudation stage (fibrous ankylosis
or bony ankylosis)
suppurative
arthritis
clinical manifestation
Systemic symptoms of infection and
poisoning
Local signs: pain, inconvenient movement
Joint flexion tenderness
Redness, swelling, heat and pain
Pathological dislocation
suppurative
arthritis
clinical manifestation
The white blood cells were
increased by laboratory test
Increased ESR
Joint puncture smear
Imaging examination: X-ray, CT,
MRI
suppurative
arthritis
Diagnosis
• Whole body +
local
• Puncture + assay
• X-ray
suppurative
arthritis
Treatment
• Systemic support therapy
• Application of antibiotics
Local treatment
• Arthroscopic treatment
• Joint puncture, pus aspiration
and antibiotic injection
• Incision drainage and
antibiotic infusion
suppurative
arthritis
suppurative
arthritis
Preservation of joint function
• Function position braking
• Functional exercise
Adjuvant therapy
suppurative
arthritis
Reconstruction of joint
function
• Osteotomy and
orthopedics
• Joint fixation
• Arthroplasty
• Arthrectomy
suppurative
arthritis
suppurative
arthritis
suppurative
arthritis
After class thinking questions
Diagnosis and treatment of
acute osteomyelitis and
chronic osteomyelitis
Thank you

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Purulent Infection of Bone and Joint.ppt