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