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ACUTE SUPPURATIVE ARTHRITIS

1. Definition

a. A joint can become infected by:

i. Direct invasion through a pentrating wound, inyrarticular injection, or arthoscopy

ii. Cronic osteomyelitis spread to joint

iii. Metastase from blood spread

2. Etiology

a. Satfilococcus aureus

b. In baby usually haemophyllus influenza

c. In adult could be gonococcus infectios

3. Pathology

a. An acute inflamatory reaction in syonovial membrane with a serous or seropurulent


exudate and increase in synofial fluid

b. The pus appears in the joint, articular cartilage is eroded and destroyed by bacterial and
celullar enzymes leucosit

c. Granulation tissue( pannus) blocking nutrition to synovial fluid, make destruction in


cartilage bone

d. If the infection is not arrested cartilage may be completly destroyed and become
ankylosis

4. Clinical features

a. In newborn infants

i. Septicimia

ii. The baby crying and refuses to feed

iii. High fever

iv. Usually in hip joint

v. The local signs of warmth, pain, resistance to movement

vi. The umbilical cord probably source of infection


b. In childrend

i. Acute pain in a single large joint( hip and knee)

ii. High feverf

iii. Decrease of the movement the joint

iv. Pain and warmth and spasme

c. In adult

i. Often in superficial joint( knee, wrist, finger, ankle or toe)

ii. Painful, swelling and inflamaed( rubor,dolor,tumor,kalor, functio laaesa)

iii. Warmt, tenderness movement restricted

iv. Examination historybof gonorrhea and drug abuse

5. Laboratory

a. Leukositosis

b. Led increase

c. Blood culture probably positive

6. Radiology

a. Soft tissue swelling

b. Lost of tissue planes

c. Widening joint space from effusion

d. Slight subluxation

e. Destruction in bone and cartillage

7. Treatment

a. The first priority is to aspirate the joint and examine the fluid

b. General supportive care: analgetic for pain and intravenous fluid for dehydration

c. Splintage and should be traction to prevent dislocation with abduction and flexed 30
degree

d. Antibotic follow the result of bactery


e. Drainage joint if any effusion from seropurlen fluid

8. Complication

a. Early complication

i. Dead because of septikimia

ii. Destruction the cartilage joint

iii. Dislocation of joint

iv. Epifisis necrosis

b. Late complication

i. Degenerative joint

ii. Permanent dislocation

iii. Fibrose ankylosis

iv. Disturbance of bone growth

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