Musculoskeletal Infections

Infections of the Bone

Gram-positive and gram-negative bacteria to

microbacteria and even fungi Biopsy for culture is necessary Osteomyelitis is an inflammation of the bone result of infection Periostitis is an infections of the subperiosteal space

 Osteomyelitis is similar to infections in other

organincreased local pressure Intramedullary canal, the pressure change produces infarction compressing the capillary and sinusoidal beds that supply it Cancellous trabeculae also are infarcted by the collapse of the vessels and also undergo necrosis These necrotic segments of bone sequestrae Reactive, viable bone around a sequestrum involucrum

Hematogenous Osteomyelitis
Hematogenous spread of bacteria to the bone is a

common event. Children the vascular anatomy at the epiphyseal growth plate Painful

Focal Osteomyelitis of the Bone

The frequent presentation of pediatric patients with

metaphyseal osteomyelitis the anatomy of the metaphyseal growth plate These large vessels frequently demonstrate a "hairpin turn" at the physis the flow of blood may be slow bacteria may lodge focus for infection

 Prolonged IV therapy often is indicated (6 weeks or

more) When possible, the sequestrum is removed entirely. Bone infections in children Staphylococcus aureus Chronic osteomyelitis fistula or chronically draining sinus

Granulomatous Osteomyelitis
A granuloma is a chronic inflammatory process with

central giant cells and macrophages with a peripheral cuff of lymphocytes and plasma cells. The most common tuberculosis.

 Typically it occurs in the spine deformity

(destruction of the vertebra) The histologic features are those of chronic osteomyelitis

fibrosis, bone destruction, and prominent caseous necrosis

Septic Arthritis
An infection of a diarthrodial joint Bacteria proliferate within the joint cavity cause marked

limitation of joint motion, and severe pain with joint loading or motion Patients with septic arthritis:

high fever, leukocytosis, and severe malaise tensely swollen, warm, and exquisitely tender

The involved joint :

 Most common in children derive from foci of

acute osteomyelitis of the metaphysis that "breaks through" into the joint. Joints where the growth plate is enclosed by the joint capsule are common sites for this event (humerus, proximal femur) The first step in the evaluation aspiration of the joint The joint fluid is examined