Orthopedics Inflammatory Process

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Orthopedics Inflammatory Process. Jan Bazner-Chandler RN, MSN, CNS, CPNP. Inflammatory Process. Osteomyelitis Septic arthritis Juvenile arthritis. Osteomyelitis. Webmd.lycos.com. Osteomyelitis. Infection of bone and tissue around bone. Requires immediate treatment - PowerPoint PPT Presentation


  • Orthopedics Inflammatory ProcessJan Bazner-Chandler RN, MSN, CNS, CPNP

  • Inflammatory ProcessOsteomyelitis

    Septic arthritis

    Juvenile arthritis

  • OsteomyelitisWebmd.lycos.com

  • OsteomyelitisInfection of bone and tissue around bone.

    Requires immediate treatment

    Can cause massive bone destruction and life-threatening sepsis

  • Pathogenesis of Acute OsteoUnder 1 yearthe epiphysis is nourished byarteries.In children 1 yearto 15 years theinfection is restrictedto below the epiphysis.

  • Clinical ManifestationLocalized painDecreased movement of areaWith spread of infectionRednessSwellingWarm to touch

  • Diagnostic Tests:X-rayCBCESR / erythrocyte sedimentation rateC-reactive proteinBone scan most definitive test for osteomyelitis

  • X-Ray18-year-old boy with painful right arm

  • Osteomyelitis

  • ManagementCulture of the bloodAspiration at site of infectionIntravenous antibiotics x 4 weeksPO antibiotics if ESR rate going downMonitor ESRDecrease in levels indicates improvement

  • Goals of CareTo maintain integrity of infected joint / joints

  • Septic ArthritisInfection within a joint or synovial membraneInfection transmitted by:BloodstreamPenetrating woundForeign body in joint

  • Septic Arthritis of HipDifficulty walking and feverDiagnosis: x-ray, ESR, aspiration of fluid from joint

  • Septic HipFlexed hip on affectedside is common presentation.

  • Diagnostic Tests


    Needle aspirationunder fluoroscopy

  • Erythrocyte Sedimentation RateESRUsed as a gauge for determining the progress of an inflammatory disease.Rises within 24 hours after onset of symptoms.

    Men:0 - 15 mm./hrWomen:0 20 mm./hrChildren:0 10 mm./hr

  • C-Reactive ProteinDuring the course of an inflammatory process an abnormal specific protein, CRP, appears in the blood.

    The presence of the protein can be detected within 6 hours of triggering stimulus.

    More sensitive than ESR / more expensive

  • Joint Space Fluid

    WBC80,000Segs88%Monos1%Lymphs11%RBC16,000Gram StainGram-positive cocci in chains

  • ManagementAdministration of antibiotics for 4 to 6 weeks.Oral antibiotics have been found to be effective if serum bactericidal levels are adequate.Fever controlIbuprofen for anti-inflammatory effect

  • Juvenile Rheumatoid ArthritisChronic inflammatory condition of the joints and surrounding tissues.

    Often triggered by a viral illness

    1 in 1000 children will develop JRA

    Higher incidence in girls

  • Clinical ManifestationsSwelling or effusion of one or more jointsLimited ROMWarmthTendernessPain with movement

  • Diagnostic EvaluationElevated ESR / erythrocyte sedimentation rate+ genetic marker / HLA b27+ RF 9 antinuclear antibodiesBone scanMRIArthroscopic exam

  • Goals of TherapyTo prevent deformities

    To keep discomfort to a minimum

    To preserve ability to do ADL

  • ManagementFirst line drugs:ASA NSAIDs Immunosuppressive drugs (oral): azulvadine or methotrexate Disease modifying drugsEnbrel - IMRemicade - IV

  • ASA TherapyAlert: The use of aspirin has been highly associated with the development of Reyes syndrome in children who have had chickenpox or flu. Because aspirin may be an an ongoing p art of the regimen of the arthritic child, parents should be warned of the relationship between viral illnesses an aspirin, and be taught the symptoms of Reyes syndrome.

  • ManagementPhysical therapyExercise programMonitor ESR levelsRegular eye exams: IriditisCardiac involvement: early studies show some correlation due to inflammatory process

  • IriditisIntraocular inflammation of iris and ciliary body

    2% to 21% in children with arthritis

    Highest incidence in children with multi joint involvement disease.

  • Clinical ManifestationsDeep eye painPhotophobiaOften report decrease in color perceptionRedness no drainage Treatment: prednisone eye drops or PO prednisone

  • Muscular DystrophyA group of more than 30 genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles that control movement.

  • Duchenne Most common form of MD and primarily affects boys.Caused by absence of dystophin a protein needed to maintain integrity of muscle. Onset between 3 and 5 yearsRapid progression: unable to walk by age 12.

  • TreatmentNo curePhysical therapyRespiratory therapySpeech therapyOrthopedic appliances / corrective proceduresMeds: corticosteroids and immununosuppressants to slow progression of the disease.