Orthopedic Infections
Musculoskeletal infections can prove to be extremely difficult to diagnose and treat due to the wide variation in clinical presentation, which often mimics other diagnoses such as trauma, and due to the potential for serious complications that can have li
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Orthopedic Infections Mark W. Zawadsky and Steven C. Scherping, Jr.
Introduction Musculoskeletal infections can prove to be extremely difficult to diagnose and treat due to the wide variation in clinical presentation, which often mimics other diagnoses such as trauma, and due to the potential for serious complications that can have lifelong implications for the patient. Unrecognized infections can destroy normal joint anatomy and function, threaten limb viability, and potentially be fatal if not recognized and treated appropriately. The most important aspect of caring for patients with a musculoskeletal infection is to come to an early and accurate diagnosis. When proper treatment is administered in a timely manner, most musculoskeletal infections can be effectively treated and the morbidity minimized with an excellent outcome for the patient. A missed infection can lead to irreversible impairment and loss of mobility for the individual, along with significant costs for society due to loss of productivity and requirements for medical care.
Pathophysiology of Osteomyelitis The pathogenesis of osteomyelitis, although conceptually similar in all cases, may vary depending upon the age of the host, duration of infection, etiology of infection, and type of host response to the infection. Osteomyelitis is often classified using these parameters which can assist in defining the severity of infection, identifying a mode of treatment, and assessing the potential for recovery. Duration of infections is often divided into either acute or chronic osteomyelitis. This also applies to infections involving the joints, such as a septic arthritis. Although the distinction is somewhat arbitrary, acute osteomyelitis is usually considered to occur within the first 6 weeks following inoculation, with chronic osteomyelitis being greater than 6 weeks. M.W. Zawadsky (B) Department of Orthopedic Surgery, Georgetown University Medical Center, 3800 Reservoir Road NW, Pasquerilla Healthcare Center (PHC), Ground Floor, Washington, DC 20007, USA e-mail: [email protected]; [email protected] S.W. Wiesel, J.N. Delahay (eds.), Essentials of Orthopedic Surgery, C Springer Science+Business Media, LLC 2010 DOI 10.1007/978-1-4419-1389-0_3,
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M.W. Zawadsky and S.C. Scherping
The development of bone and joint infections takes place via one of two basic mechanisms involving either exogenous or hematogenous pathways. Exogenous delivery involves direct inoculation of the bone from either trauma, surgery, or a contiguous focus of infection. Hematogenous delivery is via the vascular system into either osseous or synovial tissue producing a localized focus of infection. Local tissue compromise (i.e., surgery or fracture) or systemic tissue compromise (i.e., diabetes or chronic disease) is often associated with an increased risk of bone infection by either method. Two patterns of response are noted and are often dependent on the infecting organism. Pyogenic organisms elicit a rapidly progressive course of pain, swelling, abscess for
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