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  • Infectiile Osteo-Articulare: S.U.U.M.C. ""Carol Davila" Bucuresti Clinica de Ortopedie - Traumatologie

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    1) Acute hematogenous osteomyelitis is common in children, often affecting the knee. Staphylococcus aureus is the most common pathogen. Rapid diagnosis and treatment are needed due to the seriousness of the condition. 2) In children, acute hematogenous osteomyelitis usually spreads from a port of entry like a skin lesion to the metaphysis of long bones via bacteremia. Trauma can increase the risk by promoting vascularization and bacterial seeding. 3) Diagnosis involves clinical signs like fever and localized pain plus elevated inflammatory markers on labs and imaging. Treatment consists of IV antibiotics for 6 weeks followed by long-term oral antibiotics to prevent chronicization.

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    19. Osteomielite Acute

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    1) Acute hematogenous osteomyelitis is common in children, often affecting the knee. Staphylococcus aureus is the most common pathogen. Rapid diagnosis and treatment are needed due to the seriousness of the condition. 2) In children, acute hematogenous osteomyelitis usually spreads from a port of entry like a skin lesion to the metaphysis of long bones via bacteremia. Trauma can increase the risk by promoting vascularization and bacterial seeding. 3) Diagnosis involves clinical signs like fever and localized pain plus elevated inflammatory markers on labs and imaging. Treatment consists of IV antibiotics for 6 weeks followed by long-term oral antibiotics to prevent chronicization.

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    4 views28 pages

    Infectiile Osteo-Articulare: S.U.U.M.C. ""Carol Davila" Bucuresti Clinica de Ortopedie - Traumatologie

    Uploaded by

    Casandra Ro
    1) Acute hematogenous osteomyelitis is common in children, often affecting the knee. Staphylococcus aureus is the most common pathogen. Rapid diagnosis and treatment are needed due to the seriousness of the condition. 2) In children, acute hematogenous osteomyelitis usually spreads from a port of entry like a skin lesion to the metaphysis of long bones via bacteremia. Trauma can increase the risk by promoting vascularization and bacterial seeding. 3) Diagnosis involves clinical signs like fever and localized pain plus elevated inflammatory markers on labs and imaging. Treatment consists of IV antibiotics for 6 weeks followed by long-term oral antibiotics to prevent chronicization.

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    © All Rights Reserved
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    of 28

    INFECTIILE OSTEO-ARTICULARE

    S.U.U.M.C. “”Carol Davila” Bucuresti


    Clinica de Ortopedie – Traumatologie
    Infectiile osteo-articulare

    • Osteomielitele acute

    • Osteoartrite acute infectioase

    • Osteite cronice
    1- Osteomielitele acute

    • Sunt frecvente la copii


    • Articulatia genunchiului este cea mai afectata
    • Este de 2 ori mai frecventa decat artritele acute
    infectioase
    • Germenele cel mai frecvent intalnit : stafilococul auriu

    • Afectiune foarte grava (rapiditate de diagnostic si


    tratatment)
    Osteomielitele acute hematogene la copil

    Poarta de intrare
    – Lezuni cutanate ( abcese, furuncule, etc.)
    – Faringo-amigdalite

    Calea de diseminare este hematogena (bacteriemie)


    – Sediul de electie ( metafiza oaselor lungi –
    metastaza septica)
    – Pot determina astfel osteomielite dar si artrite
    septice
    Examenul clinic

    • Sindromul inflamator-infectios
    - febra 39-40 de grade
    - frisoane ( trebuie recoltate hemoculturi)
    - cefalee
    - alterarea starii generale

    • Durerea vie, localizata si pulsatila

    • Palparea segmentelor dureroase


    Ex. paraclinice
    - VSH crescut
    - PCR crescuta
    - fibrinogen crescut
    - leucocitoza cu
    neutrofilie

    Hemoculturi
    repetate in frison +

    Antibiograma Stafilococul auriu


    Osteomielitele acute hematogene la
    copil

    Radiologie : negativa in stadiile de debut


    Rolul favorizant al traumatismului
    Contuzie > tromboza > hipervascularizatie > bacteriemie cu insamantare septica
    Osteomielitele acute hematogene

    La copil
    Genunchiul
    Soldul
    Umarul
    Osteomielitele acute hematogene

    La copil La adult
    Genunchiul femurul
    Soldul C.V.
    Umarul piciorul
    Osteomielitele acute hematogene
    • La tineri este rara
    - Favorizata de imunodepresie, consum de droguri etc.
    - Sunt posibile toate localizarile osteoarticulare

    • La varstnici ( factori favorizanti)


    - Dupa o infectie genito-urinara (spondilodiscite cu
    bacili G-)
    - Insuficienta venoasa cronica favorizeaza staza
    - Diabetul zaharat
    Osteomielitele acute hematogene
    SCINTIGRAFIE OSOASA
    • diagnosticul precoce

    10 sec

    Hiperfixare precoce

    5 min
    Osteomielite acute hematogene
    Radiografiile vor fi pozitive mai tarziu

    J + 16
    RMN
    Tratamentul
    - Antibiotice
    - Asocieri de 2 antibiotice i.v
    (6 sapt)
    - Continuarea antibioterapiei
    p.o 6 L pana la 1 an

    Monitorizare biologica si Rx
    Vindecare obtinuta dupa un
    tratament precoce si durata
    suficienta

    Dupa 5 luni
    Osteomielitele acute hematogene

    FAZA DE ABCES SUBPERIOSTAL

    - FEBRA OSCILANTA
    - astenie, paloare
    - dureri osoase
    Semne locale :
    - edem
    - semne inflamatorii
    - fluctuatie
    ECOGRAFIE

    • Abcesul

    • Decolarea periostala

    • Edemul partilor moi


    Rx

    • osteoliza

    • Reactie periostala
    PUNCTIE puroi Antibiograma
    Fara tratament :
    Fistulizare si cronicizare
    Fara tratament :
    FAZA DE STARE A OSTEOMIELITEI
    CARACTERIZATA DE SECHESTARARE SI
    RECONSTRUCTIE OSOASA
    RADIOGRAFIE
    Tratementul = chirurgical : sechestrectomie
    Osteomielita acuta hematogena
    Complicatii locale:
    • Pandiafizita : infectarea intregii diafize
    • Artrite , artroze secundare , redori articulare
    • Inegalitati de lungime, dezaxari
    • Cronicizari si malignizari
    Forme cronice particulare
    • Abces Brodie
    • Intra in discutie dg
    .diferential cu osteomul
    osteoid

    H - 33 ans

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