七年制医学课件 专外 9Bone and Joint Infections.pptVIP

Infection in Bone and Joint Osteomyelitis The root words:osteon (bone) myelo (marrow) itis(inflammation) Definition:Osteomyelitis is an inflammatory process accompanied by bone destruction and caused by an infecting microorganism Etiology bacteremia Trauma Illness Malnutrition Inadequacy of the immune system Classification Osteomyelitis acute (subacute) chronic specific (eg TB) non specific(most common) Classification: Waldvogel, 1971 Waldvogel, 1971 2. Contiguous focus of infection:infections from adjacent bone or soft tissues. Contiguous focus osteomyelitis has a biphasic age distribution: the infection occurs in younger individuals secondary to trauma and related surgery and in older adults secondary to decubitus ulcers and infected total joint arthroplasties Waldvogel, 1971 3. Direct inoculation Osteomyelitis can derive from a direct infection of bone, from a source outside the body (eg, soft tissue trauma, open fracture, surgery) Classification Cierny Mader, 1985 Microbiology in various types of osteomyelitis Pathological differences based on age Basic differences exist in the pathology of osteomyelitis in infants, children, and adults. Acute haematogenous OM mostly children boys girls history of trauma Acute Osteomyelitis Source Of Infection infected umbilical cord in infants boils, tonsilitis, skin abrasions in adults UTI, in dwelling arterial line Acute OsteomyelitisOrganism Gram +ve staphylococus aureus:80% Streptococcus pyogen Streptococcus pneumonie Gram -ve haemophilus influnzae (50% 4 y) Escherichia coli pseudomonas auroginosa, proteus mirabilis Acute Osteomyelitis Pathology starts at metaphysis ?trauma vascular stasis acute inflammation suppuration necrosis new bone formation resolution Acute Osteomyelitis Acute Osteomyelitis Epiphyseal separation caused by infection in young child Acute Osteomyelitis Clinical Features severe pain reluctant to move fever malaise toxe