Bone and joint Tumors

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Slide 1 :

Infection in Bone and Joint

Slide 2 :

Infection in bone Osteomyelitis acute (subacute) chronic specific (eg TB) non specific(most common)

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Acute haematogenous OM mostly children boys> girls history of trauma

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Acute Osteomyelitis Source Of Infection infected umbilical cord in infants boils, tonsilitis, skin abrasions in adults UTI, in dwelling arterial line

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Acute Osteomyelitis Organism Gram +ve staphylococus aureus strep pyogen strep pneumonie Gram -ve haemophilus influnzae (50% < 4 y) e .coli pseudomonas auroginosa, proteus mirabilis

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Acute Osteomyelitis Pathology starts at metaphysis ?trauma vascular stasis acute inflammation suppuration necrosis new bone formation resolution

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Acute Osteomyelitis

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Acute Osteomyelitis

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Acute Osteomyelitis Clinical Features severe pain reluctant to move fever malaise toxemia

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Acute Osteomyelitis Infant failure to thrive drowsy irritable metaphyseal tenderness decrease ROM commonest around the knee

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Acute Osteomyelitis Adult commonly thoracolumbar spine fever backache history of UTI or urological procedure old ,diabetic ,immunocompromised

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Acute Osteomyelitis Diagnosis History and clinical examination FBC, ESR, B.C. X-ray (normal in the first (10-14) days Ultrasound Bone Scan Tc 99, Gallium 67 MRI Aspiration

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Acute Osteomyelitis

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Acute Osteomyelitis Differential Diagnosis cellulitis acute septic arthritis acute rheumatism sickle cell crisis Gaucher’s disease

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Acute Osteomyelitis Treatment supportive treatment for pain and dehydration splintage antibiotics surgery

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Acute Osteomyelitis Complications septicemia metastatic infection septic arthritis altered bone growth chronic osteomyelitis

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Subacute Osteomyelitis Clinical features long history (weeks, months) pain, limp swelling occasionally local tenderness

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Subacute Osteomyelitis Pathology Brodies abscess a well defined cavity in cancellous bone

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Subacute Osteomyelitis Investigation X ray Bone scan Biopsy(50%) grow organism

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Subacute Osteomyelitis Treatment antibiotics for 6 months surgery

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Other types of OM Sclerosing OM (non suppurative OM) Post-operative early (within 3 months) late

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Chronic Osteomyelitis May follow acute OM May start De Novo following operation following open #

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Chronic Osteomyelitis Organism usually mixed infection mostly staph. Aureus E. Coli . Strep Pyogen, Proteus

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Chronic Osteomyelitis Pathology cavities dead bone cloacae involucrum histological picture is one of chronic inflammation

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Chronic Osteomyelitis

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Chronic Osteomyelitis Sequestrum

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Acute Septic Arthritis Route of Infection direct invasion penetrating wound intra articular inj arthroscopy eruption of bone abscess haematogenous

Slide 28 :

Acute Septic Arthritis Organism staphylococus aureus haemophilus influenzae streptococcus pyogenes escherishae coli

Slide 29 :

Acute Septic Arthritis Pathology acute synovitis with purulent joint effusion articular cartilage attacked by bacterial toxin and cellular enzyme complete destruction of the articular cartilage.

Slide 30 :

Acute Septic Arthritis Sequelae complete recovery partial loss of the articular cartilage fibrous or bony ankylosis

Slide 31 :

Acute Septic Arthritis Neonate Picture of Septicemia irritability resistant to movement

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Acute Septic Arthritis Child Acute pain in single large joint reluctant to move the joint increase temp. and pulse increase tenderness

Slide 33 :

Acute Septic Arthritis Adult often involve superficial joint (knee, ankle, wrist) investigation fbc, wbc, esr crp ,blood culture x ray ultrasound aspiration

Slide 34 :

Acute Septic Arthritis Differential Diagnosis acute osteomyelitis trauma irritable joint hemophilia rheumatic fever gout Gaucher disease

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Acute Septic Arthritis Treatment general supportive measures antibiotics surgical drainage

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Tumour And Tumour Like Conditions of Bone benign tumours are common the most common malignant bone tumour are secondary metastasis second most common malignant bone tumours are haematogenous primary malignant tumours are rare

Slide 37 :

Metastatic Bone Tumours breast bronchus kidney prostate thyroid GI

Slide 38 :

Haematogenous Bone Tumours plasmacytoma multiple myeloma eosinophilic granuloma lymphoma leukaemia

Slide 39 :

Bone Cysts simple bone cyst fibrous dysplasia aneurysmal bone cyst

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Benign Bone Tumours osteoma osteoid osteoma osteochondroma enchondroma

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Benign Bone Tumours chondromata

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Malignant Bone Tumours osteosarcoma Ewing’s sarcoma chondrosarcoma

Slide 43 :

Bone Tumours Clinical Presentation asymptomatic pain swelling history of trauma neurological symptoms pathological fracture

Slide 44 :

Bone Tumours Imaging solitary or multiple lesions? what type of bone is involved? which part of the bone is involved? are the margins of the lesion well defined? is there bony reaction? does the lesion contain calcification?

Slide 45 :

Bone Tumours Differential Diagnosis haematoma infection stress fracture myositis ossificans gout

Slide 46 :

Bone Tumours Treatment chemotherapy radiotherapy tumour excision limb salvage surgery amputation

Slide 47 :

Tuberculosis Bone And Joint vertebral body large joints multiple lesions in 1/3 of patient

Slide 48 :

Tuberculosis Clinical Features contact with TB pain, swelling, loss of weight joint swelling decrease ROM ankylosis deformity

Slide 49 :

Tuberculosis Pathology primary complex ( in the lung or the gut) secondary spread tuberculous granuloma

Slide 50 :

Tuberculosis Spinal little pain present with abscess or kyphosis

Slide 51 :

Tuberculosis Diagnosis long history involvement of single joint marked thickening of the synovium marked muscle wasting periarticular osteoporosis +ve Mantoux test

Slide 52 :

Tuberculosis Investigation FBC , ESR, Mantoux Xray soft tissue swelling periarticular osteoporosis joint appear washed out articular space narrowing Joint aspiration AAFB identified in 10-20% culture +ve in 50% of cases

Slide 53 :

Tuberculosis differential diagnosis transient synovitis monoarticular ra haemorhagic arthritis pyogenic arthritis

Slide 54 :

Tuberculosis Treatment chemotherapy rifampicin isoniazid 8 weeks ethambutol rifampicin and isoniazid 6-12 month rest and splintage operative drainage rarely necessary

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Infection in bones and joint can be cancer or tumor. Tumor i s possible at every stage of life, bon more Infection in bones and joint can be cancer or tumor. Tumor i s possible at every stage of life, bones becomes fragile and severe pain in joints. Acute Osteomyelitis Organism leads to cancer. - Slides less
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