Inflammation is the body’s response to a particular type of stimulus damaged. It aims to locate harmful factors and their elimination. This is possible thanks to the action of many cellular immune mechanisms and so. belonging to the humoral immune system of man. Inflammation can occur in all tissues of the body. Stimuli are the most damaging chemicals, physical and biological agents or microorganisms.
In the osteoarticular system, depending on the pathogen causing inflammation can be distinguished: the non-specific inflammation – the most common bacterial, fungal or viral infections. Microbes get to the bone hematogenous other places where goes active inflammatory process (eg, lung abscess with weakened defense forces of the body).
The disease can affect any bone in the body. In children inflammation occur mostly in the femur, tibia and humerus. In adults, usually affects the bones of the pelvis or spine. The disease can occur at any age but is more common in children during the rapid growth of the body, especially in boys. Inflammation refers to the periosteum of the bone (tissue covering the bone), bone and bone marrow, and the joints can lead to permanent damage.
The disease usually is caused by bacteria – Staphylococcus aureus (S. aureus), rarely other bacteria: streptococcus, E. coli (Escherichia coli), typhoid fever and gonorrhea dwoinki. Inflammation normally transferred from a remote purulent foci, less directly from the wound created by the trauma.
To the formation of bones predispose older age, impaired immune defenses, infections, systemic diseases (eg, systemic lupus erythematosus, rheumatoid arthritis, scleroderma), prosthesis joints and diabetes. Bacteria stop bone metaphyses mainly because they are the released blood flow. The infection leads to abscess formation that can form a fistula beneath the periosteum or intraosseous. The ongoing process of purulent leads to a secondary blood supply disorders of bone formation called. martwaków.
The most common symptoms are:
- Fever – is always present, may also be the only observed symptom.
- Restriction or abolition of limb movements.
- Over the fire osteoarthritis can occur pain, swelling, redness and warming. Symptoms worsen with movement of the limb.
- In advanced stages of the disease may appear purulent fistula.
- General symptoms of inflammation – malaise, weakness, rapid heartbeat, rapid breathing, chills, muscle aches.
- In the case of untreated osteoarthritis can lead to septic shock.
In the process of bone and joint purulent it is crucial to quickly start of treatment. If the time does not start treatment abscess can penetrate through the skin will be apparent improvement, but the process goes to chronic and difficult to treat.
Suspected osteomyelitis requires urgent consultation with an orthopedic doctor. Particular attention will have to be paid to:
The occurrence of the above mentioned symptoms of osteoarthritis particularly in children under fifteen years old, diabetic or elderly.
The appearance of the treatment of other bacterial disease for oil leakage from the fistula over the bone, fever or severe pain.
In the case of suspected inflammatory doctor will perform the following tests:
General tests of blood – for inflammation characterized by: leukocytosis (elevated white blood cells), accelerated ESR, the so-called growth. acute phase proteins (eg CRP), reduced levels of hemoglobin.
Microbiological tests (culture) to detect the blood of bacteria that causes inflammation.
Bacteriological examination of the source of fire.
Imaging studies: X-ray, computed tomography and magnetic resonance imaging. The changes are visible only after two weeks of illness. These are usually necrosis of bone, periosteum buildup, the blurring of trabecular bone structure.
The differential diagnosis of inflammatory bone and joint doctor takes into account primarily:
- bone tumors: Ewing’s tumor, osteosarcoma, chondrosarcoma
- tuberculosis of bones.
Possible complications of the disease is primarily:
- Abscess and fistula pus on the skin. Fistula is usually associated with a decrease in pain and a decrease in fever. But this is not a symptom improvement because, as mentioned earlier predisposes it to move in the chronic phase of the disease.
- Fracture of the inflamed bone.
- Damage to the epiphyseal cartilage and bone as a result of this distortion and bending of the bones.
- Stiffening of the surrounding joints, contractures.
- Prolonged purulent process leads to amyloidosis.
- Sepsis (sepsis) and the formation of distant abscesses in other bones.
- Bone defects and the formation of false joints.
- Amputation of limbs due to impaired blood circulation in the limb.
Treatment of the disease is difficult due to the low penetration of the antibiotic to the place specified in general inflammation. If we give an antibiotic for three days from the beginning of inflammation is a disease we can fully heal. After this time the treatment is not generally able to stop in the bone lesion. Therefore, it is important to quickly identify and implement appropriate treatment. Diagnosis usually requires hospitalization.
The primary drug are antibiotics that are mainly given intravenously. Today, modern antibiotics may be administered orally or by intramuscular injection. Antibiotics are used long-term, sometimes even 8-10 weeks. Usually there is a need for analgesics. Is extremely important as proper diet, watering and resting in bed.
The patient should perform exercises healthy limbs especially during a long stay in hospital. During treatment, there is often a need for surgical intervention. In infants, it is a abscess incision and drainage podokostnowego oil. In older children and adults performed a wide opening of the bone, removal of pus, soft tissue fragments, dead tissue, abundant rinsing the wound and the local introduction of the antibiotic. After surgery, limb immobilization spaces.
It is the most common inflammation of the bones, representing approximately 70% of cases. It is one of the most feared complications of musculoskeletal injuries, often leads to irreversible damage to the bone and surrounding soft tissue, and then the entire limb. It may also cause damage to organs and many other systemic disorders. Pathogenic bacteria penetrate to the bone as a result of injuries incurred during open fractures and orthopedic surgery for osteoarthritis system.
Factors contributing to post-traumatic osteoarthritis are immunocompromised, breadth and depth of the damage, extensive post-traumatic hematoma, open fractures, poor provision of wounds, surgical technique errors and impaired blood supply. Treatment involves removal of the infected tissue, excision of fistulas, are used to stabilize the exterior and intensive antibiotic therapy, general and local. Dropouts soft tissue and bone grafts covered with autologous (derived from the same patient).
It is one of the forms of haematogenous osteomyelitis positioned around long bones. Resistance arises when the patient is large, and the bacteria that cause infections are less virulent. Septic focus is usually small in size, and delimits with the fibrous capsule of healthy tissue to prevent the formation of fistulas. Locally disease manifested swelling, soreness, and pain, especially at night. Typically, radiological picture is characteristic and sufficient for diagnosis.
Treatment of the disease is to evacuate the abscess, and excision of fibrous capsule covering graft loss of cancellous bone.
Arthritis may be separate disease entities, but also may be accompanied by osteoarthritis. They produce the same microorganisms, and hematogenous infection is established directly from the wound and the surrounding tissue. Locally states swelling, warming, redness and soreness movement in the joint. Usually the diagnosis is sufficient radiological picture of the pond. Treatment consists of relieving the affected joint, and in the case of purulent inflammation in the draining oil through the puncture and administration of antibiotics. Do not mastered in time can cause inflammation of the joint contracture and stiffness pathological.
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