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Musculoskeletal Infections

Musculoskeletal Infections. A. Soft tissues. B. Bones. C. Joints. A. Soft Tissues Infections. Subcutaneous tissue. Superficial soft tissue. Fascia. Muscles. Surgical wound infection. B. Bone Infections. 1. Acute Hematogenous Osteomyelitis. 2. Acute Osteomyelitis.

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Musculoskeletal Infections

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  1. Musculoskeletal Infections A. Soft tissues. B. Bones. C. Joints.

  2. A. Soft Tissues Infections Subcutaneous tissue. Superficial soft tissue. Fascia. Muscles. Surgical wound infection.

  3. B. Bone Infections 1. Acute Hematogenous Osteomyelitis. 2. Acute Osteomyelitis. a. After open fractures. b. Post O.R.I.F. 3. Chronic Osteomyelitis.

  4. 1. Acute Hematogenous Osteomyelitis • Children boys > girls x-rays • Metaphyseal or epiphyseal. 1. Soft tissue swelling (early). 2. Bone demineralization (10-14 days). 3. Late: sequestra dead bone – Involucrum (periosteal new bone)

  5. Symptoms: - Pain. - Loss of function. - Soft tissue abscess. • Investigation: - WBC ESR Bl. c/s - CRP. - Bone Scan? - MRI.

  6. Treatment: 1. Identify the organism. 2. Appropriate antibiotics. 3. Sx drainage when indicated - Abscess. - Infected tissues. - Refractory cases.

  7. 2. Acute Osteomyelitis • Aetiology: - Open fractures (classif). - ORIF • Symptoms: • Treatment: Radical I&D + Removal of hardware + Abscess.

  8. 3. Chronic Osteomyelitis • Aetiology: • Failed treatment of: - Acute Osteomyelitis. - Trauma. - Soft tissue spread. - Immunocompromised. - Diabetics. - IV drug abusers.

  9. C. Joint Infections: 1. Septic Arthritis. 2. Septic Bursitis. 3. Infected total Joint Arthroplasty.

  10. Septic Arthritis: • Age: usually children. • Aetiology: - Hematogenous. - Extension of metaphyseal osteomyelitis. - Iatrogenic procedures.

  11. Diagnosis: • Symptoms: - Pain. - Fever. • Signs: - Red, Hot. - Very sick. - ROM.

  12. Lab: - WBC ESR Bl. c/s - CRP. -Aspiration. • Treatment: (Emergency) - Sx drainage. - Antibiotics.

  13. Antimicrobial Agents in Orthopedics • Penicillin (Pen. G). • Penicillinase Resitant Synthetic Penicillins (PRSP). - Naficillin. - Oxacillin. - Cloxacillin. - Flucloxacillin.

  14. Cephlosporins - 1st generation (Ancef – velocef). - 2nd generation (Zinacef). - 3rd generation (Rocefin). • Aminoglycosides: - Amikacen - Gentamycin.

  15. Flouroquinolones: - Ciprofloxacin. • Other Abc: - Vancomycin – Clindamycin. • Antifungal. • Antimycobacterial. • Antiviral.

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