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• Osteomyelitis
• Septic arthritis
• Prosthetic infections
• Infection secondary to fracture fixation
Osteomyelitis
• Acute osteomyelitis
• Chronic osteomyelitis
• Acute-on-chronic osteomyelitis
• Brodie’s abscess
Osteomyelitis of bone
Frequency of involvement
• Femur 25%
• Tibia 27%
• Pelvis 12%
• Humerus 6%
• Calcaneum 5%
Osteomyelitis of bone
Causative Organism in Children
Haematogenous spread
Direct introduction
Haematogenous spread
• 20% of cases
• Underlying sepsis elsewhere
• Areas of increased vascularity
• Children - Metaphysis
• Adults - periosteal vessels, long bone shaft
Pathophysiology of Osteomyelitis
Consequence of “sequestra”
• Nidus
• Granulation tissue
• Pus
• Sequestra
• Involucrum
• Cloaca
• Sinuses
Clinical features of Osteomyelitis
• Pain
• Fever
• Malaise
• Neurological deficit eg spine
Clinical features of Osteomyelitis
• Plain X-ray
• Bone scan
• Ultrasound
• MRI
Differential diagnosis of
osteomyelitis
• Osteoid osteoma
• Neoplasm eg Ewings sarcoma, Lymphoma
Metastatic disease
Management of Osteomyelitis
Spine
• disc space
• biopsy essential for diagnosis
• differential diagnosis is tuberculosis
• often requires surgical drainage
• paraplegia is a real danger
Tuberculous Osteomyelitis
Cornerstone of management
• Repeated debridements
• Reconstructive surgery
• Adults
• Pain
• Swelling
• Fever
• Pseudoparalysis
Acute bacterial arthritis
Differential diagnosis
• Gout
• Pseudogout
• Rheumatoid arthritis
• Reactive arthritis eg Poncet’s arthritis
Acute bacterial arthritis
• Diagnosis
Management
• Antibiotic therapy
Acute bacterial arthritis
X-ray features
• osteoporosis
• sub-articular erosion
• joint destruction
Septic arthritis of the hip
Infancy
Childhood
• fever
• refusal to walk
• restricted hip motion
• subluxation on X-ray
Septic arthritis of the hip
• Open
• Arthroscopic
Antibiotic therapy in infection
• Osteomyelitis 12 weeks
Management
• Antibiotic therapy