Orthopaedic INFECTION post operative surgical site

SSI

1. 
Next to trauma, the commonestNext to trauma, the commonest orthopaedic orthopaedic
problem is infection. problem is infection.

Infection of bone is - osteitis Infection of bone is - osteitis

Infection marrow is – myelitisInfection marrow is – myelitis

Osteum- bone Osteum- bone

Itis – infection Itis – infection

2. Types of infections of the boneTypes of infections of the bone
SpecificSpecific .TB. osteomyelitis .TB. osteomyelitis
. Syphilitic osteomyelitis. Syphilitic osteomyelitis
Nonspecific Nonspecific . Staphylococcus. Staphylococcus
. Streptococcus. Streptococcus
. Pnuemococcus. Pnuemococcus
. Salmonella. Salmonella
. E.coli. E.coli
. Cl.welchi. Cl.welchi

3. CommonestCommonest

Blood born Blood born

Other rootsOther roots
Lymphatic spread Lymphatic spread
Direct spread – compound fractures Direct spread – compound fractures

4. 
Decreased body resistance Decreased body resistance

Measels Measels

Malaria Malaria

HIVHIV

Upper end of tibia Upper end of tibia

Lower end of femurLower end of femur

Upper end of humerus Upper end of humerus

5. MetaphysisMetaphysis
. Hair pin bent arrangement of capillaries. Hair pin bent arrangement of capillaries
. Lack of phagocytosis . Lack of phagocytosis
. More prone for trauma . More prone for trauma

6. Hair pin bent arrangement of Hair pin bent arrangement of
capillariescapillaries

7. . Loculus formation . Loculus formation
. Inflammatory oedema . Inflammatory oedema
. block of exists and entrances . block of exists and entrances
. Formation of abscess . Formation of abscess
. More oedema – increased tension . More oedema – increased tension

8. Out comeOut come
1.1. Good antibioticGood antibiotic
Good resistance Good resistance eradication of diseaseeradication of disease
22. Moderate resistance. Moderate resistance
. . More virulenceMore virulence localised abscesslocalised abscess
. . Irregular antibioticIrregular antibiotic (Brodies)(Brodies)
3. No antibiotics 3. No antibiotics
. Poor resistance extension of infection . Poor resistance extension of infection

9. ExtensionExtension
. . periosteumperiosteum
Sub periosteal abscessSub periosteal abscess
Sinus formation Sinus formation
. . Medullary cavityMedullary cavity
. . sequestrumsequestrum – cancellous tissue – cancellous tissue
cortical bonecortical bone

10. Sub periosteal abscessSub periosteal abscess

11. RepairRepair

Blood supply-periosteum increasesBlood supply-periosteum increases

New bone formation New bone formation

Involucrum formation Involucrum formation

Cloaca formationCloaca formation

Separation of sequestrum Separation of sequestrum

Fate of sequestrumFate of sequestrum
Small – absorbed Small – absorbed
Medium – comes out as bony chips Medium – comes out as bony chips
large – surgical removallarge – surgical removal

12. SequestrumSequestrum

13. Acute Acute
Subacute Subacute
Chronic Chronic
GarriesGarries

14. Symptoms and signs Symptoms and signs
GeneralGeneral
.. Usually in children Usually in children
. Sudden onset . Sudden onset
. High fever . High fever
. Head ache. Head ache
. Rest less ness . Rest less ness
LocalLocal
Inflamation at metaphyseal areaInflamation at metaphyseal area
Redness, pain, swelling, Tenderness Redness, pain, swelling, Tenderness
Flexion of near by jointFlexion of near by joint
earlyearly stage – stage – no swellingno swelling
swellingswelling –– sub periosteal abscess sub periosteal abscess

15. BloodBlood
. Total count- increases. Total count- increases
. Differential count – leucocytosis. Differential count – leucocytosis
. C reactive protein – increases. C reactive protein – increases
X-rayX-ray
. Early stage – nil significant . Early stage – nil significant
. Late stage –periosteal-stripping, elevation. Late stage –periosteal-stripping, elevation
loss of tissue planesloss of tissue planes

16. Acute OsteomyelitisAcute Osteomyelitis

17. Acute OsteomyelitisAcute Osteomyelitis

18. 
Acute rheumatism Acute rheumatism

Cellulitis Cellulitis

Ewings tumour Ewings tumour

Acute pyogenic arthritis Acute pyogenic arthritis

19. A . A . GeneralGeneral
High calorie protein diet High calorie protein diet
B . B . LocalLocal
Rest to the part Rest to the part
C . C . AntibioticsAntibiotics
for one month for one month
D . D . SurgerySurgery
multiple drill holes multiple drill holes
pus for culture and sensitivitypus for culture and sensitivity

20. Clinical featuresClinical features
. Multiple sinuses . Multiple sinuses
. Repeated break down of wounds. Repeated break down of wounds
. Thickening, broadening, irregularity of . Thickening, broadening, irregularity of
bonebone
. Presence of sequestrum . Presence of sequestrum
. Presence of cavity. Presence of cavity

21. X-rayX-ray
. Presence of sequestrum . Presence of sequestrum
. Irregularity of bone . Irregularity of bone
. New bone formation . New bone formation
. Cavitation . Cavitation

22. Chronic OsteomyelitisChronic Osteomyelitis

23. Chronic Osteomyelitis

24. Part A Part A
. Sequestrectomy . Sequestrectomy
Part BPart B
. Cavity- sauserisation. Cavity- sauserisation
Part C Part C
. Big cavities filled with muscle. Big cavities filled with muscle
. Local antibiotics-gentamycin pellets . Local antibiotics-gentamycin pellets

25. . Growth disturbances. Growth disturbances
. Pathological fractures . Pathological fractures
. Epithelioma . Epithelioma
. Involvement of joint. Involvement of joint
. Septic arthritic . Septic arthritic
. Bone ankylosis . Bone ankylosis

26. . “A cavity surrounded by densely sclerosed bone . “A cavity surrounded by densely sclerosed bone
with small sequestrum in side”with small sequestrum in side”
Clinical featuresClinical features
. Deep boring pain . Deep boring pain
. Swelling in the metaphysis. Swelling in the metaphysis
. Irregularity & thickening of bone . Irregularity & thickening of bone
TreatmentTreatment
. Deroofing. Deroofing
. Antibiotic . Antibiotic
. Analgesics . Analgesics

27. Brodies abscessBrodies abscess

28. Brodies abscessBrodies abscess