152016Feb

Septic Arthritis and Osteomyelitis

SEPTIC ARTHRITIS

This condition is an infection of the lining of the joint (synovium), by bacteria that get into the blood stream and lodge in the joint. An inflammation occurs and fluid collects into the joint space causing severe pain, fever, swelling of the joint, joint irritation and limitation of joint movement. Children are more commonly affected than adults. The main site is the knee joint, followed by the hip, elbow, shoulder and ankle. When the lower limb is involved, the child refuses to walk and limps. The joint feels hot and tender. The condition needs urgent admission, investigation and intravenous antibiotics. All the joints can be aspirated with a needle and syringe except the hip joint which is deep and requires surgical drainage in theatre. The pus is sent for laboratory studies. Recovery is good if treatment is early (less than 5 days). Later the pus becomes thick and surgery is required. Joint changes can occur with limited movement and stiffness in late cases.

Left hip septic dislocation

OSTEOMYELITIS

Is defined as bacterial infection of the bone marrow. It is more common in growing children (neonates to ± 14 years). It affects the ends of growing bone especially around the knee joint region and the hip region. It is less common in the upper limbs and foot bones. Common in lower socio-economic groups. The child may complain of pain in the limb. A limp is common when the lower limb is involved. On examination of the child, there is tenderness, swelling and a high fever. The child is usually ill looking with a raised heart rate. As the infection progresses bone gets destroyed by pus formation within the bone and the child becomes very ill. Other sites such as the lungs and heart may get infected. The pus that forms can spread down the bone and become superficial under the skin as an abscess. These cases need surgery to remove the pus. The condition requires urgent admission to hospital, splinting the of limb and high doses of antibiotics and pain relief. In early cases the infection can be controlled and healing occurs with antibiotics. In late cases (after 5 days) bone destruction can lead to fractures, chronic bone infection with discharge of pus through the skin, and growth problems, leading to severe disability and joint stiffness. Acute osteomyelitis can also occur with open fractures but the severity of the infection is not as severe as the infection that occurs at the ends of the bone through blood spread infection.

Osteomyelitis humerus

OSTEOARTICULAR TUBERCULOSIS

This is tuberculous infection of the bone and joint. Tuberculosis is still prevalent in our country. It commonly affects the lung, but any organ can be affected without chest infection. The common site is the spinal bones in any age group. The ends of long bones may be affected in children. In spinal involvement two vertebrae are commonly involved through the blood stream. The diseased vertebrae can collapse resulting in a deformity of the spine called a gibbus. Patients may also have weakness of the lower limbs due to pressure on the spinal cord. Bone tuberculosis, at the ends of bone, can cause cysts in the bone or destruction of the end of bone, entering into the joint. Joint involvement alone can occur with infection of the lining of the joint (synovium). This results in thickening of the joint lining causing swelling of the joint with fluid accumulation into the joint. In long standing joint tuberculosis, deformity of the joint occurs with difficulty in walking and restricted joint movement. Early tuberculosis can be treated with anti TB drugs. Late cases of the spine, bones and joints, require surgery to remove pus and infected tissue resulting in joint deformities. Tuberculosis can be diagnosed by skin tests, blood tests, x-rays and a biopsy is needed to confirm the diagnosis.

Dr R Rasool

TB ankle

TB knee

Dislocated right hip secondary to TB septic arthritis