Professional Documents
Culture Documents
By: Rismayanti. H (C 111 07 245) Advisor : dr. Rico dr. Luthfi SUPER !S"R: dr. #. S$%ryadi S%."&
PA&!E0& !'E0&!&1
History T#$ing
Chief complaint : Wound & discharge at the right knee Anamnesis : Suffered since 1 month ago before admitted to Wahidin hospital. Pain ( !" fe#er ($!" %istor& of fe#er ( ! since ' months ago" s(elling ( !. %istor& of operation (ith implantation on the right femur and right tibia on )o#ember *+11 at Wahidin hospital due to traffic accidents. %e (as ridding and got hit b& another motorc&cle from opposite direction.
%hysic#l E&#min#tion
7(n(ra, Stat$s : Composmentis,-ood nourished ita, Si-n
.P:
oc#li'e( St#t)s
Ri-*t 8n(( r(-io
6nspection:
Wound on anterior aspect of right 7nee si8e of * 2 1 cm" serous discharge ( ! " reddish and blackish color around the (ound " deformit& ($!" hematoma ($!" edema ( !
Palpation :
09::
Acti#e and passi#e motions of knee ;oint are limitted due to pain.
)<=:
C03 > *?
C INICA I!AGING
R#(iologic E&#min#tion
Plate & screws are visualized at 1/3 distal of femur, callus forming on the fracture line (+), cortex irreguler and narrowing !itic lesion at right femur (the sign of acute osteom"elitis) #one mineralisation is decrease $oint s%ace and soft tissue still inta&
Plate & 'crews are visualized at 1/3 distal of ti(ia, callus forming on the fracture line (+) !itic lesion at os ti(ia and fi(ula ( the sigh of acute osteom"elitis) #one mineralisation is decrease (sign of osteo%orosis senilis) )arrowing of femoroti(ial *oint es%eciall" still inta& 'oft tissue still inta& at medial as%ect (osteoarthritis genu), an&le *oint
#*or#tory Fin(ing
Laboratory examination WBC RBC HGB HCT PLT GDS Ur/ Cr GOT /GPT CT /BT HBsAg L&D '"( ) '"( )) Results 7,3 x 103 3.92 x 106 10,4 32,5 465 x 103 153 25/0,9 20/12 800/300 !g"#$% 116 123
RESUME
+ male , ,1 "ears old with (ound and discharge at the right knee, since 1 months (efore admitted to wahidin hos%ital Pain (+), -istor" of fever (+) since . months ago, swelling (+) -istor" of o%eration with im%lantation on the right femur and right ti(ia on novem(er /011 at wahidin hos%ital due to traffic accidents %e (as ridding and got hit b& another motorc&cle from opposite direction 1n %h"sical examination of the right &nee 2 3ound on anterior as%ect of right &nee size of /x1 cm, serous discharge (+), reddish and (lac&ish color around the wound, deformit" (4), hematoma (4), edema (+)
Di#gnosis
Chronic
!#n#gement
:edicamentosa:
Antibiotic
Surger&:
=ebridement 0emo#e
of implant
DISCUSSION
Osteomyelitis
1!(*r"2 1!(*r"2
1!(*r"2
B*+6 *% ./,$s -$ %!r$*r0 B*+6 " + $ %!r$*r ./,$3 r"(/s 1.P/,$3 r"(/s 2. )sx4$"2 #/,.
L$ !" "s.!r" -($+ 1/30 P!3#$ !"2 2$ !, 2$ !" "s.!r" L$ !" "s.!r", "++. #/,!r32!
O,#/r"#*r O,#/r"#*r
1.O,#/r"#*r 2.S3$"s#$3
Gra!ilis
O,#/r"#*r
'e!tineus
1!(*r"2
Semimembrano sus (i!e)s "emoris * Lon% +ea# (i!e)s "emoris *S+ort +ea#
'()inition o) "st(omy(,itis
3he
root (ords osteon (bone! and m&elo (marro(! are combined (ith itis (inflammation! 9steom&elitis is an infectious process that in#ol#es bone and its medullar& ca#it& (hich leads to a subseAuent 6nflammator& process.
C,assi)i+ation
Bas(d
on ons(t
Hem#togeno)s
Acute Chronic
So$r+( o) in)(+tion
%ematogenous Contagenous =irect
Cont#geno)s
Direct infection
Port D entry
6nfection
A+$t( "st(omy(,itis
9 9
Acute haematogenous osteom&elitis is mainl& a disease of children Btiolog&: Staph. aureus" gram$negati#e bacili" group . streptococcus
Infection in the met#+hysis may spread towards the surface, to form a subperiosteal abscess Some of the *one m#y (ie, #n( is enc#se( in periosteal new bone as a sequestrum The enc#sing involucrum is sometimes perforated by sinuses
%#thology
$nflammation (uppuration Bone &ecrosis
ascular con!estion "#udation of the fluid $nfiltratin! by P%&
Pus form within the bone and forces it way alon! the ol'man canal to the surface where it produce subperiosteal abcess
&ew bone forms from the deep layers of the periosteum involucrum
$n some cases, remodellin! may restore the normal contour) $n others, the bone is left permanently deformed
Si-n 9 Sym%toms
Signs
3he patient" usuall& a child" presents (ith se#ere pain" malaise and a fe#er 6n infants" elderl& patients" or immunocompromised patients" clinical findings ma& be minimal. Pain and local tenderness are common findings.
:a3oratory
3he
most certain (a& to confirm the clinical diagnosis is to aspirate pus from the metaph&seal subperiosteal abscess or the ad;acent ;oint. 3he W.C and C0P #alues are usuall& high. .lood culture is positi#e in onl& about half the cases of pro#en infection.
PCA6)
D$0AE
!ma-in-
Standard radiographs generall& are negati#e" but ma& sho( soft$ tissue s(elling. Skeletal changes" such as periosteal reaction or bone destruction" generall& are not seen on plain films until 1+ to 1* da&s into the infection
The first x-ray, 2 days after symptoms began, is normal it always is; metaphyseal mottling and periosteal changes were not obvious until the second film, taken 1 days later; eventually much of the shaft was involved!
Soft
tissue s(elling (earl&!" bone deminerali8ation (1+$11 da&s!" seAuestra (dead bone (ith surrounding granulation tissue!" and in#olucrum (periosteal ne( bone! later. :06 : e2tremel& sensiti#e" e#en in the earl& phase of bone infection" and can help to differentiate bet(een soft$tissue infection and osteom&elitis. 0adioscintigraph& Sensiti#e but not specific.
A.2!6s S6s#!( O% Or#4*."!+$3s A + 1r"3#/r!s 94 &+$#$*
!#n#gement
Supporti#e treatment for pain and deh&dration Splintage of the affected part Antibiotic therap& Surgical drainage
Com%,i+ation
Chronic Osteomyelitis
Chronic
continuation
of
)o( da&s" it more freAuentl& follo(s an open fracture or operation. @sual organisms are staph&lococcus aureus" Bscherichia coli" Streptococcus p&ogens" Proteus and Pseudomonas.
Pat*o,o-y
.one
is destro&ed or de#itali8ed in a discrete area at the focus of infection. Ca#ities containing pus and pieces of dead bone (seAuestra! are surrounded b& #ascular tissue" and be&ond that b& areas of sclerosis the result of chronic reacti#e ne( bone formation. 3he histological picture is one of chronic inflammator& cell infiltration around areas of acellular bone or microscopic seAuestra.
B$OP(*
+,old (tandard-
C/$&$C./
DIAGNOSIS
$%.,$&,
/.BOR.0OR*
C,ini+a, )(at$r(s
Pain"
p&re2ia" redness and tenderness ha#e recurred" or (ith a discharging sinus. 3here ma& be a sero$purulent discharge and e2coriation of the surrounding skin.
:a3oratory
BS0 and (hite blood cell count ma& be in+r(as(d 9rganisms cultured from discharging sinuses should be tested repeatedl& for antibiotic sensiti#it&.
!ma-in D$ra&
e2amination
resorption (ith thickening there are marked #ariation:
.one
there ma& be no more than locali8ed loss of trabecculation" or a area osteoporosis" periosteal thickening" seAuestra sho( up as unnaturall& dense fragments.
A.2!6s S6s#!( O% Or#4*."!+$3s A + 1r"3#/r!s 9#4 &+$#$*
C3 and :06
Sho( the e2tent of bone destruction and reacti#e edema" hidden abscess and seAuestra
/ana-(m(nt
Antibiotics 9peration :
=ebridement =ealing Soft
tissue co#er
Com%,i+ation
Th#n$ 4o)