INFLAMATORY DISORDERS OF BONES AND JOINTS

INFLAMATORY PROCESS:

INFLAMATION : - Biological event

- The local reaction of living tissue to an

irritant

-Reactive process : cell + exudates-accumulative-irritated

tissue
Gambar 1
-Clinical manifestation :

a. rubor ( redness )

b. tumor ( swelling )

c. calor ( heat )

d. dolor ( pain )

e. functiolaesa ( loss of function )

Gambar 2
-Redness and heat :

- vascular response

- dilatation of local blood vessel +

increased rate of flow

-Swelling :

- formation of an exudate

- emigration of various type of leucocytes

-Pain :

- increased local pressure within the tissue

Gambar 3
-Loss of function :

- pain and swelling initially

- destrution of tissue

- dense scar formation

Gambar 4
TYPES OF INFLAMATORY DISORDERS OF BONES AND JOINTS

1. Specific infection :

- casuative organism - detected

a. pus producing infection ( pyogenic )

- osteomyelitis

- septic arthritis

- tenosynovitis
Gambar 5
 b. Granulomatous (granuloma producing)

- tuberculous osteomyelitis

- tuberculous arthritis

2. Nonspecific and idiophatic inflamatory types of Rheumatic desease

- Rheumatic fever

- Transient synovitis

- Rheumatoid arthritis

- Spondylitis
Gambar 6
3. Chemical irritant

- Metabolic arthritis Gout

4. Repeated Physical Irritant

- Bursitis

- Tenovaginitis stenosans
Gambar 7
PYOGENIC BACTERIAL INFECTION

Principles of antibacterial therapy :

-Hours and days

-Bacteriostatic (tetracycline, chloramphenicol, erythromicin)-

decreased multification

-Bactericidal (penicillin, chepalosporin) kill bacteria

ideal antibiotic.
Gambar 8
-AB high concentrationnon-toxic

-Perenteral (im or iv) more effective

-Monitoring laboratory weekly

-Periods ( 4 6 ) weeks

-Relative slow diffussion :

- intact local blood supply

- local pressure

- accumulation purulentdecompression
Gambar 9
ACUTE HEMATOGENOUS OSTEOMYELITIS

Incidence :

-Growing bones

-Boys : girls 4 : 1

-Long bones : - femur

- tibia

- humerus

- radius

- ulna and fibula

-site : metaphyseal region unique blood supply

Etilogi :

-staphylococcus aureus 90%

-Portal de entry : - through the skin

-upper respiratory infection

-local trauma
Pathogenesis :

1. Kearah cortex

2. Menembus periosteum

3. Menyebar ke medulla

4. Menyebar ke joints
GEJALA KLINIS :

Fase akut : - (10-15) hari

- anak tampak sangat sakit

-panas tinggi

-pembengkakan

-gangguan fungsi

-lab : - LED meningkat

- leukositosis

-radiologik: : tidak dijumpai kelainan

Fase kronik :

- rasa sakit tidak begitu berat

- daerah lesi merah dan bengkak

- fistel ( + )

- radiologik : - involucrum

- sequester
PENATALAKSANAAN :

Osteomyelitis akut :

1. perawatan dirumah sakit

2. pengobatan supportif

3. pemeriksaan kultur

4. AB broad spetrum

5. immobilisasi

6. operatif
-Osteomyelitis kroniktidak dapat sembuh sempurna

-Indikasi pembedahan :

1. sequester

2. abscess

3. rasa sakit yang hebat

4. keganasan