Bone and Jont, tumours and Infection

Slideshow Transcript

1. Slide 1: Infection in Bone and Joint
2. Slide 2: Infection in bone Osteomyelitis acute (subacute) q chronic q specific (eg TB) q non specific(most common) q
3. Slide 3: Acute haematogenous OM mostly children q boys> girls q history of trauma q
4. Slide 4: Acute Osteomyelitis Source Of Infection infected umbilical cord in infants q boils, tonsilitis, skin abrasions q in adults UTI, in dwelling arterial line q
5. Slide 5: Acute Osteomyelitis Organism Gram +ve q staphylococus aureus q strep pyogen q strep pneumonie q Gram -ve q haemophilus influnzae (50% < 4 y) q e .coli q pseudomonas auroginosa, q proteus mirabilis q
6. Slide 6: Acute Osteomyelitis Pathology starts at metaphysis q ?trauma q vascular stasis q acute inflammation q suppuration q necrosis q new bone formation q resolution q
7. Slide 7: Acute Osteomyelitis
8. Slide 8: Acute Osteomyelitis
9. Slide 9: Acute Osteomyelitis Clinical Features severe pain q reluctant to move q fever q malaise q toxemia q
10. Slide 10: Acute Osteomyelitis Infant failure to thrive q drowsy q irritable q metaphyseal tenderness q decrease ROM q commonest around the knee q
11. Slide 11: Acute Osteomyelitis Adult commonly thoracolumbar spine q fever q backache q history of UTI or urological procedure q old ,diabetic ,immunocompromised q
12. Slide 12: Acute Osteomyelitis Diagnosis History and clinical examination q FBC, ESR, B.C. q X-ray (normal in the first (10-14) days q Ultrasound q Bone Scan Tc 99, Gallium 67 q MRI q Aspiration q
13. Slide 13: Acute Osteomyelitis
14. Slide 14: Acute Osteomyelitis Differential Diagnosis cellulitis q acute septic arthritis q acute rheumatism q sickle cell crisis q Gaucher’s disease q
15. Slide 15: Acute Osteomyelitis Treatment supportive treatment for pain and q dehydration splintage q antibiotics q surgery q
16. Slide 16: Acute Osteomyelitis Complications septicemia q metastatic infection q septic arthritis q altered bone growth q chronic osteomyelitis q
17. Slide 17: Subacute Osteomyelitis Clinical features long history (weeks, months) q pain, limp q swelling occasionally q local tenderness q
18. Slide 18: Subacute Osteomyelitis Pathology Brodies abscess a well defined cavity in cancellous bone
19. Slide 19: Subacute Osteomyelitis Investigation X ray q Bone scan q Biopsy(50%) grow organism q
20. Slide 20: Subacute Osteomyelitis Treatment antibiotics for 6 months q surgery q
21. Slide 21: Other types of OM Sclerosing OM (non suppurative OM) q Post-operative q early (within 3 months) q late q
22. Slide 22: Chronic Osteomyelitis May follow acute OM q May start De Novo q following operation following open #
23. Slide 23: Chronic Osteomyelitis Organism usually mixed infection q mostly staph. Aureus E. Coli . Strep q Pyogen, Proteus
24. Slide 24: Chronic Osteomyelitis Pathology cavities q dead bone q cloacae q involucrum q histological picture is one of chronic q inflammation
25. Slide 25: Chronic Osteomyelitis
26. Slide 26: Chronic Osteomyelitis Sequestrum
27. Slide 27: Acute Septic Arthritis Route of Infection direct invasion penetrating wound q intra articular inj arthroscopy eruption of bone abscess q haematogenous q
28. Slide 28: Acute Septic Arthritis Organism staphylococus aureus q haemophilus influenzae q streptococcus pyogenes q escherishae coli q
29. Slide 29: Acute Septic Arthritis Pathology acute synovitis with purulent joint effusion q articular cartilage attacked by bacterial q toxin and cellular enzyme complete destruction of the articular q cartilage.
30. Slide 30: Acute Septic Arthritis Sequelae complete recovery q partial loss of the articular cartilage q fibrous or bony ankylosis q
31. Slide 31: Acute Septic Arthritis Neonate Picture of Septicemia irritability q q resistant to movement
32. Slide 32: Acute Septic Arthritis Child Acute pain in single large joint reluctant to move the joint q q increase temp. and pulse q increase tenderness
33. Slide 33: Acute Septic Arthritis Adult often involve superficial joint (knee, ankle, q wrist) investigation q fbc, wbc, esr crp ,blood culture q x ray q ultrasound q aspiration q
34. Slide 34: Acute Septic Arthritis Differential Diagnosis acute osteomyelitis q trauma q irritable joint q hemophilia q rheumatic fever q gout q Gaucher disease q
35. Slide 35: Acute Septic Arthritis Treatment general supportive measures q antibiotics q surgical drainage q
36. Slide 36: Tumour And Tumour Like Conditions of Bone benign tumours are common q the most common malignant bone tumour q are secondary metastasis second most common malignant bone q tumours are haematogenous primary malignant tumours are rare q
37. Slide 37: Metastatic Bone Tumours breast q bronchus q kidney q prostate q thyroid q GI q
38. Slide 38: Haematogenous Bone Tumours plasmacytoma q multiple myeloma q eosinophilic granuloma q lymphoma q leukaemia q
39. Slide 39: Bone Cysts simple bone cyst q fibrous dysplasia q aneurysmal bone cyst q
40. Slide 40: Benign Bone Tumours osteoma q osteoid osteoma q osteochondroma q enchondroma q
41. Slide 41: Benign Bone Tumours chondromata
42. Slide 42: Malignant Bone Tumours osteosarcoma q Ewing’s sarcoma q chondrosarcoma q
43. Slide 43: Bone Tumours Clinical Presentation asymptomatic q pain q swelling q history of trauma q neurological symptoms q pathological fracture q
44. Slide 44: Bone Tumours Imaging solitary or multiple lesions? q what type of bone is involved? q which part of the bone is involved? q are the margins of the lesion well defined? q is there bony reaction? q does the lesion contain calcification? q
45. Slide 45: Bone Tumours Differential Diagnosis haematoma q infection q stress fracture q myositis ossificans q gout q
46. Slide 46: Bone Tumours Treatment chemotherapy radiotherapy tumour excision limb salvage surgery amputation
47. Slide 47: Tuberculosis Bone And Joint vertebral body q large joints q multiple lesions in 1/3 of patient q
48. Slide 48: Tuberculosis Clinical Features contact with TB q pain, swelling, loss of weight q joint swelling q decrease ROM q ankylosis q deformity q
49. Slide 49: Tuberculosis Pathology primary complex ( in the lung or the gut) q secondary spread q tuberculous granuloma q
50. Slide 50: Tuberculosis Spinal little pain q present with abscess or kyphosis q
51. Slide 51: Tuberculosis Diagnosis long history q involvement of single joint q marked thickening of the synovium q marked muscle wasting q periarticular osteoporosis q +ve Mantoux test q
52. Slide 52: Tuberculosis Investigation FBC , ESR, q Mantoux q Xray soft tissue swelling q periarticular osteoporosis joint appear washed out articular space narrowing Joint aspiration AAFB identified in 10-20% q culture +ve in 50% of cases
53. Slide 53: Tuberculosis differential diagnosis transient synovitis q monoarticular ra q haemorhagic arthritis q pyogenic arthritis q
54. Slide 54: Tuberculosis Treatment chemotherapy q rifampicin isoniazid 8 weeks ethambutol rifampicin and isoniazid 6-12 month rest and splintage q operative drainage rarely necessary q