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    Bone - Infection Tanpa Anotasi

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    rifanird
    This document discusses bone infection (osteomyelitis). It describes the types of organisms that can cause osteomyelitis, including bacteria, fungi, and parasites. The routes of infection are hematogenous spread, direct invasion through open fractures or wounds, and direct spreading from nearby sites. Acute hematogenous osteomyelitis is more common in children and adults with lowered immunity. Signs and symptoms, treatments including antibiotics and surgery, and complications are outlined for both acute and chronic osteomyelitis. Acute suppurative arthritis is also briefly discussed.

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    Bone - Infection Tanpa Anotasi

    Uploaded by

    rifanird
    55 views75 pages
    This document discusses bone infection (osteomyelitis). It describes the types of organisms that can cause osteomyelitis, including bacteria, fungi, and parasites. The routes of infection are hematogenous spread, direct invasion through open fractures or wounds, and direct spreading from nearby sites. Acute hematogenous osteomyelitis is more common in children and adults with lowered immunity. Signs and symptoms, treatments including antibiotics and surgery, and complications are outlined for both acute and chronic osteomyelitis. Acute suppurative arthritis is also briefly discussed.

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    7. Bone_infection Tanpa Anotasi

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    This document discusses bone infection (osteomyelitis). It describes the types of organisms that can cause osteomyelitis, including bacteria, fungi, and parasites. The routes of infection are hematogenous spread, direct invasion through open fractures or wounds, and direct spreading from nearby sites. Acute hematogenous osteomyelitis is more common in children and adults with lowered immunity. Signs and symptoms, treatments including antibiotics and surgery, and complications are outlined for both acute and chronic osteomyelitis. Acute suppurative arthritis is also briefly discussed.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    55 views75 pages

    Bone - Infection Tanpa Anotasi

    Uploaded by

    rifanird
    This document discusses bone infection (osteomyelitis). It describes the types of organisms that can cause osteomyelitis, including bacteria, fungi, and parasites. The routes of infection are hematogenous spread, direct invasion through open fractures or wounds, and direct spreading from nearby sites. Acute hematogenous osteomyelitis is more common in children and adults with lowered immunity. Signs and symptoms, treatments including antibiotics and surgery, and complications are outlined for both acute and chronic osteomyelitis. Acute suppurative arthritis is also briefly discussed.

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    © All Rights Reserved
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    of 75

    Bone Infection

    (osteomyelitis)

    DEPT ORTHOPAEDIC & TRAUMATOLOGY


    Types of organism
    •Pyogenic osteomyelitis or arthritis
    •Chronic granulomatous reaction
    •Fungal infection
    •Parasitic infestation
    Route of Infection
     Hematogenous system
     Direct invasion: Open Fx,
    operation, skin puncture
     Direct spreading
    Acute Hematogenous
    Osteomyelitis
    Acute Hematogenous
    Osteomyelitis
    • Common in children
    • Adult – lowered resistance by drug: immunosuppressive drug,
    debility disease: DM, AIDS
    - more common in vertebrae than long bone
    • Post-trauma: hematoma or fluid collection in bone
    Pathogenesis

    Source of Infection

    Blood stream

    Metaphysis

    Venous stasis

    Bacterial colonization
    Etiology
    Aerobic organisms
    -Gram positive : Staphylococcus aureus ,
    Streptococcus pyogens
    Streptococcus pneumoniae
    -Gram negative : Haemophilus influenza,
    E.coli, Pseudomonas aeruginosa,
    Proteus mirabilis,
    Anaerobic organisms
    Bacteroides fragilis
    Pathology
     Inflammation
     Suppuration
     Necrosis
     New bone formation
     Resolution
    Inflammation
    • First 24 hours
    • Vascular congestion
    • Polymorphonuclear leukocyte infiltration
    • Exudation
    • Intraosseus pressure  intense pain
     intravascular thrombosis 
    ischemia
    Suppuration
     2-3 days
     Pus formation
     Subperiosteal abscess
    via Volkmann canals
     Pus spreading
     epiphysis
     joint
     medullary cavity
     soft tissue
    Necrosis
    • Bone death by the end of a week
    • Bone destruction ← toxin
    ← ischemia
    • Epiphyseal plate injury
    • Sequestrum formation
    • small  removed by macrophage,osteoclast.
    • large  remained
    New bone formation
    • By the end of 2nd week
    • Involucrum (new bone formation from deep
    layer of periosteum ) surround infected tissue.
    • If infection persist- pus discharge through
    sinus to skin surface Chronic osteomyelitis
    Resolution
    Antibiotics Surgical drainage

    Infection is controlled

    Bone remodeling
    Resolution
    • Infection is controlled
    • Intraosseous pressure release
    • With healing – new bone formation + periosteal reaction  bone
    thickening and sclerosis
    • Remodeling to normal contour or deformity
    Infection persist

    Chronic drainage

    Chronic Osteomyelitis
    Signs and Symptoms in infant

    Drowsy
    Irritable
    Fails to thrive
    Metaphyseal tenderness and resistance to joint movement
    Signs and Symptoms in child

    Severe pain
    Malaise
    Fever
    Toxemia
    History of recent infection
    Local inflammation pus
    escape from bone
    Lymphadenopathy
    Acute osteomyelitis in adult

    1.Uncommon
    2.History of DM.
    3.Immunosuppressive drug
    4.Drug addict
    5.Elderly patients.
    Signs and Symptoms in adult

    Fever
    Pain
    Inflammation
    Acute tenderness
    Common site is thoraco-
    lumbar spine
    Radiographic studies

    rarefaction, area of lytic and sclerotic


    lesion, sequestrum and involucrum.
    Bone Scan
     99m TC-HDP - sensitive
    - not specific
     67 Ga-citrate or 111 In-labeled
    leukocyte more specific
    MRI

    pus & blood


    Aspiration pus
     confirm diagnosis
     smear for cell and organism
     culture and sensitivity test
    Investigations
     CBC
     ESR
     Hemoculture positive ~ 50%
     Antistaphylococcal antibody titer (in doubtful case)
    Differential diagnosis
     Cellulitis
     Acute suppurative arthritis
     Acute rheumatism
     Gaucher’s disease – Pseudo- osteitis, resembling
    osteomyelitis, enlargement of spleen and liver.
    Because of predisposing to infection, antibiotics
    should be given.
     Sickle-cell crisis – mimic osteomyelitis, in
    endemic area of Salmonella, it is wise to treat with
    antibiotics until infection is excluded
    Treatment for acute
    osteomyelitis
     Supportive treatment
     Splint
     Antibiotic therapy
     Surgical drainage
    Supportive treatment

     Analgesics
     Correction of dehydration
    Splint

    -Plaster slab
    -traction
    -Prevent joint contracture
    Surgical drainage

     Early treatment no need surgery


     Late treatment surgical drainage about 1/3 of cases. If pus
    found and release no need to drill bone. But drilling one or two holes if
    no obvious abscess.
    Antibiotics
    Initial antibiotics “ BEST GUESS ”
    - according to smear findings
    - according to incidences , age.
    Proper antibiotics
    - according to culture and sensitivities test
    Guideline for initial antibiotics
    Age Pathogen Drugs
    1.Older children and -Staphylococcal - Fluclaxocillin and
    previously fit adults infection fusidic acid IV 3-4 day
    oral 3-6 wks
    2.Children <4 years -Gram neg. infection -2nd generation
    -Haemophilus Cephalosporins or
    infection Amoxycillin with
    clavulanic acid

    3.Sickle-cell patient -Salmonella infection - Co-trimoxazole


    - Amoxycillin with
    clavulanic acid
    4.Heroin addicts and -Unusual infection : -3rd or newer generation
    immuno-compromised pseudomonas , Cephalosporins
    patients proteus, bacteroides
    Acute osteomyelitis
    •When infection subside, movement is
    encourage. Walk with crutches and full
    weight bearing is possible after 3-4
    weeks.
    Complication
     lethal outcome – rare
     metastatic infection (multifocal
    infection)
     suppurative arthritis
     very young patient
     metaphysis is intracapsular
     metastatic infection
    Complication
     altered bone growth
     chronic osteomyelitis
    - delay diagnosis and treatment
    - debilitated patients
    - compromised host
    Chronic Osteomyelitis
    Chronic osteomyelitis
    • Sequel to acute hematogenous osteomyelitis
    • Usual organisms are staph. aureus, Escherichia coli, Strep. pyogens,
    Proteus and Pseudomonas (always mixed infections)
    • In the presence of foreign implants : Staph. Epidermidis is the
    commonest pathogen.
    Pathology of chronic osteomyelitis

    • Bone is destroyed in a discrete area or diffuse


    • Cavities containing pus and sequestrum are surrounded by vascular bone
    and sclerosis bone resulted from reactive new bone formation
    • Sequestra, foreign implants act as substrates for bacterial adhesion,
    ensuring the persistence of infection and sinus drainage
    • Pathological fracture
    Signs and Symptoms of chronic
    osteomyelitis
    •Pain
    •Pyrexia
    •Redness
    •Tenderness
    •Draining sinus
    •Excoriation of skin
    Radiographic study
    • A patchy loss of bone density with thickening and sclerosis of the
    surrounding bone
    • Sequestra : dense fragment in contrast to surrounding vascularized
    bone
    • Sinogram may help to localize the site of infection
    Sequestrum
    Radioisotope scanning
    • 99m TC-HDP Up take
    • 67 Ga-citrate or 111In-labelled
    leukocyte more specific
    CT – Scan and MRI
    • Show extent of bone destruction
    and reactive edema, hidden abscess
    and sequestrum
    • Pre-op planning investigation
    Other Investigations
    •CBC
    •ESR
    •Antistayphylococcal antibody titers – Dx
    hidden infection and tracking progress to
    recovery
    •C/S from draining discharge R/O
    resistance bacteria
    Treatment for chronic
    osteomyelitis
    •Medical treatment
    •Local treatment
    •Surgical treatment
    Antibiotics
    • To stop spreading of infection
    • To control acute flare
    • Capable of penetrating sclerotic bone and non-toxic to body
    Surgical treatment
    •Sequestrectomy :
    sulphan blue stained
    only vital tissue
    •Continuous irrigation 3-
    6 weeks.
    •Gentamicin beads
    Space filling techniques
    • Papineau technique (Papineau et al 1979)
    • Muscle flap + skin graft (Fitzgerald et al 1985)
    • Myocutaneous island flap. (Yoshimura et al 1989)
    Prognosis
    •Local trauma must be avoided
    •Any recurrent of symptoms should be
    taken seriously and investigated
    Acute Suppurative Arthritis

    Route of infection
    1. direct invasion
    2. eruption of a bone abscess
    3. hematogenous spreading
    Causal Organisms
    • Staphylococcus aureus
    • Hemophilus influenza
    • E. coli
    • Streptococcus
    • Proteus
    Oganism

    Synovial membrane
    Acute inflammatory
    reaction

    Seropurulent exudate pus

    Bacterial enzyme Synovial enzyme

    Joint destruction
    Septic Arthritis
    TB Arthritis
    Signs and symptoms in newborn

    • Clinical of septicemia : irritable, refuses to feed, rapid pulse


    • Joint swelling
    • Tenderness and resistance to movement of the joint
    • Look for umbilical infection
    Signs and symptoms
    in children

    • acute pain in single joint : hip.


    • Pseudoparesis.
    • Swelling and inflammation of the joint.
    • Child looks ill.
    • Limit movement of the joint.
    • Look for a source of infection : toe, boil, otitis media
    Signs and symptoms in adult

    • Often superficial joint : knee, wrist, ankle


    • Pain
    • Swelling and inflammation
    • Restricted movement
    • Examined for gonococcal infection or drug abuse.
    Radiographic study
    Early : usually normal , joint space may seem to be widened
    (because of fluid in the joint)
    Late : osteoporosis ,narrowing and irregularity of the joint apace.
    with E. coli infection there is sometime gas in the joint
    Investigation
    • CBC
    • ESR
    • Gram stain of synovial fluid
    • C/S
    Differential diagnosis
    •Acute osteomyelitis: in children
    indistinguishable from septic joint
    •Trauma: traumatic synovitis
    •Irritable joint : the patient does not look
    ill
    •Hemophilic bleeding
    •Rheumatic fever
    •Gout and pseudogout
    Treatment of septic arthritis
    • Supportive care : analgesics, fluid
    supplement , splint, traction
    • Antibiotics
    : same as acute osteomyelitis
    • Drainage
    : Aspiration, arthrotomy
    Treatment of septic arthritis

    • Once the conditions improved, if the articular cartilage is preserved –


    gentle and gradually increasing active motion
    • If articular cartilage is destroyed – the joint is immobilized in optimal
    position until ankylosis is sound
    Outcome After Healing
    • Complete resolution
    • Partial loss articular cartilage and fibrosis of joint.
    • Loss of articular cartilage and bony ankylosis
    • Bone destruction and permanent deformity of the joint.
    Complication
    •Cartilage destruction
    •Growth disturbance
    •Bone destruction

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