Orthopedics 5th year, 2nd lecture (Dr. Omar Barawi)
-
Upload
college-of-medicine-sulaymaniyah -
Category
Health & Medicine
-
view
704 -
download
5
Transcript of Orthopedics 5th year, 2nd lecture (Dr. Omar Barawi)
ACUTE HAEMATOGENOUS OSTEOMYELITIS
Assistant prof. : Dr. Omer BarawiConsultant Orthopedist
Children ( commonest ) Adult ( immunodepresive conditions )
Staphylococcus aureus Streptococcus pyogenes strep. Pneumonia Haemophilus influenzae sickle-cell anaemia ..salmonella The organisms usually settle in the metaphysic at
the growing end of a long bone, possibly because the hairpin arrangement of capillaries slows down the rate of blood flow.
In young infants the epiphysis may be involved. In adults ,haematogenous infection is more
common in the vertebrae than in the long bones.
Inflammation Suppuration Necrosis New-bone formation Resolution
usually a child , presents with pain, malaise and
fever; inneglected cases toxaemia may be marked. Sometimes a history of a preceding skin lesion, an injury or a sore throat may be obtained.
In infants, especially in the newborn, the
constitutional disturbance can be misleadingly mild;the baby simply fails to thrive and is drowsy but irritable. Suspicion should be aroused by a history of birth difficulties or umbilical artery catheterization. There may be metaphysel tenderness and resistance to joint movement. Always look for other sites – multiple infections are not uncommon.
In adults the commonest site of haematogenous
infection is the spine. Suspicious features are backache and a mild fever, possibly following a urological procedure. It may take weeks for x-ray signs to appear, and then the diagnosis may need to be confirmed by fine-needle aspiration and bacteriological culture.
Plain radiograph MRI Radio-isotope scans may show increased
activity
C-reactive protein ( 12 -24 hrs) increasing ESR ( 24-48 hrs) increasing Hb (decreasing) Anti staphylococcual – antibody titre Aspirate pus from the subperiosteal abscess Blood culture WBC (increased)
Celllulitis Acute sapurative arthritis Ewing’s sarcoma Osteosarcoma Streptococal necrotizing myositis Rheomatic fever (acute rhiomatism ) Sickle cell- crisis Gaucher’s disease Stress fracture
Spread Infection may spread to the joint (septic arthritis)
or to other bones (metastatic osteomyelitis). Growth disturbance If the physis is damged, there may later be
shortening or deformity. Persistent infection Treatment must be prompt and effective.”Too little
too late” may result in chronic osteomyelitis
Antibiotics … pus culture, blood culture flucloxacillin and fusidic acid ( usually for 1 or 2 weeks) and is then followed
by oral antibiotics for another 3-6 weeks If methicillin-resistant Staphylococcus aureus
(MRSA) appears, vancomycine is the antibiotic of choice.
Analgesics Splintage Drainage Follow up