CH Osteo

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Chronic osteomyelitis

When the duration of osteomyelitis is more than 3 weeks, its called ch. Osteomyelitis. Causes1.Trauma causing open fractures. 2.Post operative. 3.Osteomyelitis with chronic etiology- TB - Brodies abscess. - Fungal osteomyelitis.

Pathology.
1. Necrosis. stage of new bone formation involucrum. with sequestrum inside, there will always be a persistent discharging sinus. pus from bone escapes through multiple hole in involucrum

Clinical features .

Pain, swelling. Discharging sinus. Bone thickening. Deformity. Joint stiffness. Shortening of limb, Pathological fracture. Sinus track malignancy.

Discharging sinus

Investigation.
CBC, ESR. Pus for c/s. X ray sequestrum deformity. - periosteal thickening, sclerotic lesion. - irregular soft tissue shadow. - regional osteoporosis. - pathological fracture , micro fracture. CT. MRI

D/D1.TB osteomyelitis- watery discharge. - previous h/o TB, sinus with undermined margin with blue colour. 2. Ewing's sarcoma- A primary malignant tumor of bone, usually arising as a central tumor in long bone. (biopsy) 3. Soft tissue chronic infection. (X-ray)

Treatment.
Supportive treatment . Antibiotics to prevent spread. Surgery sequestretomy + saucerization (excavation of the tissue of a wound to form a shallo )

Complication.
Joint stiffness. Shortening. Muscle contracture. Pathological fracture. Sinus track malignancy. Amyloidosis.

Brodies abscess
- it is an intraosseous abscess walled by reactive bone Cause- staph.aureus. Common site- metaphysis of long bone, cancellous bone. Clinical features- pain, fever, swelling, thickening of bone,

X- ray
radiolucent area in sub periosteum surrounded by sclerotic bone. TreatmentFenestration + antibiotics (two days of intravenous antibiotics and then oral antibiotics for six weeks )

Septic arthritis
Collection of pus inside the joint. Common in knee and hip. Cause- staph. Aureus, strept. pyogens, E. coli, pseudomonas, haemophilous influenza,

Mode of infection1.Haematogenous. 2.Direct penetrating wound to joint, 3.Joint aspirations, steroid injection, contrast injection, arthroscopy. 4.Spreading infection from near by bone.

Mode of infection
Microbes synovial membrane inflammation (synovitis). increased synovium formation seorus/ seropurulent discharge erosion of cartilage spreading of pus to the bone and destruction of bone. - escaping of pus outside the joint through sinus.

Clinical features
Neonates- increased pulse rate, fever, irritable, ignore feeding, swelling of joint, resist the movement of affected joint, pain. Children- swelling, increased pulse rate, fever, restriction of movement of joint. Adult- usually in immunocompromised or with other existing diseases.

Investigation.
CBC, ESR. Pus for c/s , gram staining. Blood for c/s X-ray initially normal. - initially increased joint space. - later joint space decreases. - osteopenia. USG- collection of pus inside the joint space.

D/D
Acute osteomyelitis. Haemarthaesis.- post traumatic. - aspiration. Acute rheumatism. Haemophilic joint Gout.

Treatment
Supportive measures- 2 wks of IV antibiotics followed by 4-6 wks of oral antibiotics. Symptomatic.(pain, fever) Splintage of affected limb. Surgery arthotomy and evacuation of pus.

Complications.
Dislocaton of joint. Deformity around joint. Bony ankylosis.

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