Osteomyelitis and Infective arthritis

Acute hematogenous osteomyelitis

-          Causes

• Aerobic organisms
  • Gram positive organism
    • Staphylococcus aureus
    • Streptococcus pyogens
    • Streptococcus pneumonia
  • Gram negative organism
    • Haemophilus influenza
    • Escherichia coli
    • Pseudomonas aeruginosa
    • Proteus mirabilis
• Anaerobic organisms
  • Bacteroides fragilis

-          Pathophysiology

• Metaphysis
  • arterio - venous junction (A-V junction)

-          Pathology

•  Inflammation, Suppuration, Necrosis, New bone formation, Resolution

-          Clinical Feature

-          Investigation

• Blood test
  • CBC, ESR, CRP
  • H/C
  • Anti-staphylococcal antibody titer
• Aspiration & tissue gram stain
• Plain film
  • lytic and sclerotic lesion
  • sequestrum
  • involucrum
• Bone scan
  • Technetium 99 scan
  • Gallium 67 WBC scan
  • Indium 111 WBC scan
• MRI : peripheral enhancement

-          DDx

• Cellulitis
• acute suppurative arthritis
• streptococcal necrotizing myositis
• acute rheumatism
• Gaucher’s disease (pseudo- osteitis)
• sickle-cell crisis

-          Treatment

• Non operative
  • Correct malnutrition, dehydration
  • pain control
  • Joint contracture deformity prevention
  • antibiotics
• Operative
  • Drainage

-          Complication

• Septic arthritis
• Growth disturbance
• pathological fracture
• chronic osteomyelitis

 Chronic osteomyelitis (COM)

-          Causes

-          Pathophysiology

-          Pathology

• sclerotic bone
• Sequestrum
• sinus tract
• pathological fracture

-          Clinical Feature

• sinus drainage
• excoriation of skin
• Low grade fever

-          Investigation

• Blood test
• Aspiration & tissue gram stain
• Plain film
  • dense sclerotic bone :sequestrum
  • radiolucent area :granulation
• Bone scan
• MRI

-          Treatment

• Non operative
  • Wound care
  • Antibiotic
• Operative
  • Sequestrectomy

Infective arthritis

-          Causes

• Bacteria
• TB
• Fungi
• Parasite
• Mix

-          Pathophysiology

-          Pathology

-          Clinical Feature

• High grade fever
• Septicemia
• pseudoparesis

-          Investigation

• Blood test
  • CBC, ESR, CRP
  • H/C
• Aspiration & tissue gram stain
  • gram smear, culture & sensitivity test
  • Sugar, Protein
• Plain film
  • Early : joint space widening
  • Delayed: Joint space narrowing
• Bone scan
• MRI

-          DDX

• Acute hematogenous osteomyelitis
• hemophilic bleeding
• rheumatic fever
• gout and pseudogout
•  traumatic synovitis

-          Treatment

• Non operative
  • Supportive care
  • Antibiotic : cephalosporin
• Operative
  • joint debridement andsynovectomy
    • arthrotomy
    • arthroscopy
    • Corrective osteotomy
    • Arthrodesis
    • Arthroplasty