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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

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Orthopedics Inflammatory Process

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orthopedics inflammatory process

Orthopedics Inflammatory Process

Jan Bazner-Chandler


inflammatory process
Inflammatory Process
  • Osteomyelitis
  • Septic arthritis
  • Juvenile arthritis


  • Infection of bone and tissue around bone.
  • Requires immediate treatment
  • Can cause massive bone destruction and life-threatening sepsis
pathogenesis of acute osteo
Pathogenesis of Acute Osteo

In children 1 year

to 15 years the

infection is restricted

to below the


Under 1 year

the epiphysis is

nourished by


clinical manifestation
Clinical Manifestation
  • Localized pain
  • Decreased movement of area
  • With spread of infection
    • Redness
    • Swelling
    • Warm to touch
diagnostic tests
Diagnostic Tests:
  • 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

  • Culture of the blood
  • Aspiration at site of infection
  • Intravenous antibiotics x 4 weeks
  • PO antibiotics if ESR rate going down
  • Monitor ESR
    • Decrease in levels indicates improvement
goals of care
Goals of Care
  • To maintain integrity of infected joint / joints
septic arthritis
Septic Arthritis
  • Infection within a joint or synovial membrane
  • Infection transmitted by:
    • Bloodstream
    • Penetrating wound
    • Foreign body in joint
septic arthritis of hip
Septic Arthritis of Hip
  • Difficulty walking and fever
  • Diagnosis: x-ray, ESR, aspiration of fluid from joint
septic hip
Septic Hip

Flexed hip on affected

side is common presentation.

diagnostic tests15
Diagnostic Tests


Needle aspiration

under fluoroscopy

erythrocyte sedimentation rate
Erythrocyte Sedimentation Rate
  • 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
C-Reactive Protein
  • During 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
  • 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
Juvenile Rheumatoid Arthritis
  • Chronic 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 manifestations
Clinical Manifestations
  • Swelling or effusion of one or more joints
  • Limited ROM
  • Warmth
  • Tenderness
  • Pain with movement
diagnostic evaluation
Diagnostic Evaluation
  • Elevated ESR / erythrocyte sedimentation rate
  • + genetic marker / HLA b27
  • + RF 9 antinuclear antibodies
  • Bone scan
  • MRI
  • Arthroscopic exam
goals of therapy
Goals of Therapy
  • To prevent deformities
  • To keep discomfort to a minimum
  • To preserve ability to do ADL
  • First line drugs:
    • ASA
    • NSAIDs
  • Immunosuppressive drugs (oral): azulvadine or methotrexate
  • Disease modifying drugs
    • Enbrel - IM
    • Remicade - IV
asa therapy
ASA Therapy
  • 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.
  • Physical therapy
  • Exercise program
  • Monitor ESR levels
  • Regular eye exams: Iriditis
  • Cardiac involvement: early studies show some correlation due to inflammatory process
  • Intraocular inflammation of iris and ciliary body
  • 2% to 21% in children with arthritis
  • Highest incidence in children with multi joint involvement disease.
clinical manifestations28
Clinical Manifestations
  • Deep eye pain
  • Photophobia
  • Often report decrease in color perception
  • Redness no drainage
  • Treatment: prednisone eye drops or PO prednisone
muscular dystrophy
Muscular Dystrophy
  • A group of more than 30 genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles that control movement.
  • 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.
  • No cure
  • Physical therapy
  • Respiratory therapy
  • Speech therapy
  • Orthopedic appliances / corrective procedures
  • Meds: corticosteroids and immununosuppressants to slow progression of the disease.