Transcript Orthopedics Inflammatory Process

Orthopedics Inflammatory Process
Jan Bazner-Chandler
RN, MSN, CNS, CPNP
Inflammatory Process
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Osteomyelitis
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Septic arthritis
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Juvenile arthritis
Osteomyelitis
Webmd.lycos.com
Osteomyelitis
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Infection of bone and tissue around bone.
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Requires immediate treatment
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Can cause massive bone destruction and life-threatening
sepsis
Pathogenesis of Acute Osteo
Under 1 year
the epiphysis is
nourished by
arteries.
In children 1 year
to 15 years the
infection is restricted
to below the
epiphysis.
Clinical Manifestation
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Localized pain
Decreased movement of area
With spread of infection
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Redness
Swelling
Warm to touch
Diagnostic Tests:
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X-ray
CBC
ESR / erythrocyte sedimentation rate
C-reactive protein
Bone scan – most definitive test for osteomyelitis
X-Ray
18-year-old boy with painful right arm
Osteomyelitis
Management
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Culture of the blood
Aspiration at site of infection
Intravenous antibiotics x 4 weeks
PO antibiotics if ESR rate going down
Monitor ESR
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Decrease in levels indicates improvement
Goals of Care
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To maintain integrity of infected joint / joints
Septic Arthritis
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Infection within a joint or synovial membrane
Infection transmitted by:
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Bloodstream
Penetrating wound
Foreign body in joint
Septic Arthritis of Hip
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Difficulty walking and fever
Diagnosis: x-ray, ESR, aspiration of fluid from joint
Septic Hip
Flexed hip on affected
side is common presentation.
Diagnostic Tests
X-ray
Needle aspiration
under fluoroscopy
Erythrocyte Sedimentation Rate
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ESR
Used as a gauge for determining the progress of an
inflammatory disease.
Rises within 24 hours after onset of symptoms.
Men:
0 - 15 mm./hr
Women: 0 – 20 mm./hr
Children: 0 – 10 mm./hr
C-Reactive Protein
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During the course of an inflammatory process an
abnormal specific protein, CRP, appears in the blood.
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The presence of the protein can be detected within 6
hours of triggering stimulus.
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More sensitive than ESR / more expensive
Joint Space Fluid
WBC
80,000
Segs
88%
Monos
1%
Lymphs
11%
RBC
16,000
Gram Stain
Gram-positive cocci in
chains
Management
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Administration of antibiotics for 4 to 6 weeks.
Oral antibiotics have been found to be effective if serum
bactericidal levels are adequate.
Fever control
Ibuprofen for anti-inflammatory effect
Juvenile Rheumatoid Arthritis
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Chronic inflammatory condition of the joints and
surrounding tissues.
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Often triggered by a viral illness
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1 in 1000 children will develop JRA
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Higher incidence in girls
Clinical Manifestations
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Swelling or effusion of one or more joints
Limited ROM
Warmth
Tenderness
Pain with movement
Diagnostic Evaluation
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Elevated ESR / erythrocyte sedimentation rate
+ genetic marker / HLA b27
+ RF 9 antinuclear antibodies
Bone scan
MRI
Arthroscopic exam
Goals of Therapy
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To prevent deformities
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To keep discomfort to a minimum
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To preserve ability to do ADL
Management
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First line drugs:
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ASA
NSAIDs
Immunosuppressive drugs (oral): azulvadine or
methotrexate
Disease modifying drugs
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Enbrel - IM
Remicade - IV
ASA Therapy
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Alert: The use of aspirin has been highly associated
with the development of Reye’s 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 Reye’s syndrome.
Management
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Physical therapy
Exercise program
Monitor ESR levels
Regular eye exams: Iriditis
Cardiac involvement: early studies show some correlation
due to inflammatory process
Iriditis
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Intraocular inflammation of iris and ciliary body
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2% to 21% in children with arthritis
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Highest incidence in children with multi joint involvement
disease.
Clinical Manifestations
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Deep eye pain
Photophobia
Often report decrease in color perception
Redness no drainage
Treatment: prednisone eye drops or PO prednisone
Muscular Dystrophy
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A group of more than 30 genetic diseases characterized
by progressive weakness and degeneration of the skeletal
muscles that control movement.
Duchenne
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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 years
Rapid progression: unable to walk by age 12.
Treatment
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No cure
Physical therapy
Respiratory therapy
Speech therapy
Orthopedic appliances / corrective procedures
Meds: corticosteroids and immununosuppressants to
slow progression of the disease.