management

Definition

Rare low-grade malignant tumour

- cell of origin unknown

Epidemiology

Usually second or third decade of life

Site

90% diaphysis of tibia 

Mandible

X-ray

Most common anterior cortex of tibia

Definition

Systemic Connective Tissue Disease

Chronic inflammatory disease resulting from abnormal immunoregulation

Aetiology

Unknown

Thought similar to RA

1.  Genetic factors

2.  Environmental factors

Epidemiology

Young females

F:M 9:1

Peak 35 years old

Definition

Acute disease

- characterised by generalized rigidity & convulsions

- caused by exotoxins/neurotoxins produced in Clostridia Tetani infections

Epidemiology

Annual world mortality is 1 million

West 15-100/year

Aetiology / Pathology

Clostridium Tetani

- anaerobic

- spore-bearing Gram positive Bacillus

Definition

Clostridial Myonecrosis

- necrotizing, gas producing infection of skeletal muscle 2° Clostridia

- life threatening & rapidly progressive

Classification

There are 3 types of bacterial gas-forming infections

1. Classical clostridial gas gangrene

- rapid onset of sepsis / couple of days

- muscle nearly always involved

- critically ill immediately following an open injury 

CRMO

Very rare

- Mainly affects children

Characterised by multiple osteomyelitic changes

- predominantly in metaphyseal region of long bones

All cultures negative

Antibiotics do not affect course of disease

Pain is most common symptom

Management Principles

Stage the infection, the host & the management 

1.  Stage host / maximise healing potential

2.  Stage infection / MCS / sensitivities

3.  Debride all infected bone and ST

4.  Stabilise skeleton

5.  Eliminate dead space

6.  Soft tissue coverage

Definition

Infection of bone 2° blood-borne bacteria

Epidemiology

Most common children

- peak 10 years

True haematogenous OM rare in adults

- usually involves spine

M: F 2:1

Site

Most common femur & tibia

Definition

Joint inflammation secondary pyogenic organism

Epidemiology

All age groups

Usually children

- 50% < age 3

M= F

Any joint

- Infants = Hip

- Children = Knee

- Adults = Large Joints

IVDU - SCJ & SIJ

Pathogenesis

Two Routes

Types

Dystrophic or Metastatic

1.  Metastatic 

- hypercalcaemia / hyperphosphatemia

2.  Dystrophic 

- more common

- onto damaged connective tissue

- tendon / ligament / cartilage

- calcific tendonitis shoulder

- Pellegrini-Steida lesion MCL

Pathology

Deposited around chondrocytes & into avascular portion of CT