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
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