Post on 03-Jun-2018
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Musculoskeletal Infection
Punto DewoDept. of Orthopaedics & Traumatology
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Bone and Joint Infection
Osteomyelitis
Septic arthritis
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How do infecting organisms enter
bones or joints
Hematogenous spread
Inoculation through wounds
Extension from adjacent infected
structures
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Inoculation
through
traumatic
wounds,
operations
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Extension
from adjacent
infected
structures
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Hematogenous spread
Bacteremia
Sluggish circulationin metaphysis
(in children)
Foci spread subperiosteal
abscess () draining sinus
(infants) foci spread through
growth plate
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Involucrum : new bone formationencircling cortical shaft
Sequestrum : dead bone surrounded by pusor scar tissue
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Acute hematogenous osteomyelitis
Male : female = 2 : 1
> 90% monostotic
> 90% lower extremity
The child limpor refuse to walkor
refuse to use the extremityinvolved
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Early acute: w/in 24-48 hrs, only pain
and fever Late acute: 4-5 days after onset,
subperiosteal abscess needs
surgical drainage Neonates
Older children
Premature infants
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Evaluation of Acute Osteomyelitis
CBC, ESR, CRP
Blood culture : ident. causative
organism in 50% Bone aspiration : for subperiost
abscess, ident. 70%
X-Ray : could be normal Bone scan Tc 99m
MRI scan
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Treatment of Acute Osteomyelitis
I.V Antibiotic started promptly
S. aureusmost common infecting
agent
Gram ()ve organism in vertebrae
and immunocomp pts
Surgery for late acute (draining
abscess)
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Complications
Recurrent osteomyelitis : to minimize
AB coverage for 6 weeks
Distant seeding
Septic arthritis
Pathologic fracture due to
osteonecrosis
Growth arrest due to damaged gr. pl.
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Subacute Hematogenous
Oeteomyelitis Less virulent org + effective immune
response
Less clear onset, older children ( 2-16 y.o), equiv sex ratio
No or mild fever, mild tenderness
Lab findings inconclusive
AB for 6 weeks
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Chronic Hematogenous
Osteomyelitis Sx several weeks-months
Developed vs developing countries
Child : neglected cases
Adult : secondary
Sequestra, involucrum, draining
sinus
Needs culture from bone/deep tissue
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Treatment of Chronic Osteomyelitis
Aggressive debridement
Bone grafting
Antibiotic beads (local)
Soft tissue coverage
Systemic antibiotic for 6-12 weeks
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Trisna Rahardja, M, 46 yo,
Chronic osteomyelitic of the distal third
of the left tibia and fibula post ORIF
on 2008
Didik R M 20 yo
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Didik R, M, 20 yo
Chronic osteomyelitis of the right tibia fibula with bone
defect post nailing
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Septic Arthritis
More common in children < 5 y.o
S. aureus, > 95% monoarticular,
hematogenous or extension fromadjecent structures
41% knee, 23% hip, 14% ankle, 12%
elbow, 4% wrist, 4% shoulder Cartilage eroded
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Clinical feature
Pain and swelling in affected joint
Malaise, fever, limp, refuse to walk,
refuse to move extremity(pseudoparalysis)
Joints held in comfy positions
CBC, ESR, X-Ray, joint aspiration
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Synovial fluid analysis:
-Turbid
-Yellow to creamy pus
-WBC > 50.000/mm3
-Glucose decreased
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Treatment of Septic Arthritis
i.v antibiotic promptly
Surgical irrigation and drainage
Open or arthroscopic
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complications
Joint destruction
Bony ankylosis
Soft tissue ankylosis (Tuberculosis)
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Clinical Feature
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X-ray of the Left lower leg
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Cellulitis
Subcutaneous
Less distinctive margins
Local signs + lymhadenopathy
Th/ Systemic + Local
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Erysipelas
Similar to cellulitis BUT more
superficial
Well demarcated and painful plaque Th/ Systemic + Local
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Necrotizing Fasciitis
Muscle fascia
Aggressive and life threatening
Etiology : Streptococcus Group A
Requires emergent and extensive
surgical debridement
Gas Gangrene
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Gas Gangrene Muscle
In grossly contaminatedtraumatic wounds
Etiology :
Clostridium Perfringens
and Clostridium Welchii
Need surgical debridement
and fasciotomy
Hyperbaric chamber
therapy
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