Infections of bone and joint

Dr. Pradeep Fernando MS, FRCS

Joint infection - Bacterial

Occur in
Children
Diabetics
Immuno-compromised
Septicaemia esp. neonatal
following direct innoculation



Diagnosis
Pain, swelling, fever (maybe masked
DM, immuno-comp. partially treated)

Warmth, redness, effusion, zero
movement

ESR, WBC/DC, CRP, aspirate
Management
General fluids, anti-pyretic, analgesic,
QHT
Specific IV antibiotic broad spectrum

Surgery Must be drained. Arthrotomy.
Close skin. IV for 2-3 days after fever has
settled. Oral for 3-6 weeks.
rehabilitation
Complications
Can cause a septicaemia

Destruction of joint surface

Destruction of the head of the femur in
neonates Tom Smith arthropathy
Joint infection - TB
May have only vague pain and effusion
May have TB foci elsewhere
Diagnosis by aspiration, PCR, CXR or
synovial biopsy

X-ray shows rarefaction of bone
Infection of bone


Two main types
Haematogenous children, immuno-
compromised
Post-traumatic
Acute haematogenous osteomyelitis
Classically early in the 2
nd
decade.
Growing end of long bones due to
slowing of the circulation
Pain, swelling, fever, decreased
movement
O/E swollen, red, tender, warm. There
maybe associated joint effusion. Septic
focus.
Diagnosis
clinical features.
ESR.
WBC/DC.
CRP.
Blood culture.
X-ray maybe negative
Note maybe masked by partial treatment


Treatment
Supportive
fluids,
rest,
QHT,
analgesics,
anti-pyretic

Definitive
IV antibiotics cefuroxime, gentamicin
if fever not settling in 48 hours, or if being seen after 48 hours
then surgery





Pathology
Bacteria lodge beneath the periosteum
Produce pus. Forms a sub-periosteal
abscess
Bone from which the periosteum has been
stripped dies sequestrum
New bone forms under the periosteum
involucrum
Cloacae and sinuses form chronic OM
Chronic osteomyelitis

Chronic osteomyelitis
Various forms post acute osteomyelitis
Post traumatic
Brodies abscess




TB affects fingers TB dactylitis, spine
Chronic osteomyelitis
Treatment is difficult.-
guttering
curettage
removal of sequestrum
Antibiotics local and systemic
muscle flaps
Spinal infections
Para discal based on blood flow

Bacterial, TB

New bone formation seen in bacterial
infection treatment - antibiotics
Spinal infections - TB
Potts disease. Can cause paraplegia.
Diagnosis- x-ray bone destruction. Par-
vertebral abscess
Treatment ATT. May need surgery

Some miscellaneous conditions
Trigger finger
Tennis elbow
Achilles tendinitis
Plantar fasciitis
De Quervains