ACUTE SUPPURATIVE ARTHRITIS

Explanation:

Ans. is ‘b’ i.e., Staphylococcus aureus

• Bacteria are the most common pathogens in acute skeletal infections.

o The microbial spectrum is deverse in suppurative arthritis, but staphylococcus aureus infection is most common.

Salmonella is the most common cause of osteomyelitis in children with sickle cell anemia.

Explanation:

Ans. is ‘a’ i.e., Knee

Ans. is ‘a’ i.e., Knee [Ref Ebnezar 3″/e p. 385]

Septic arthritis (Acute suppurative arthritis)

• Septic arthritis refers to pyogenic infection of a joint, i.e., infection of a joint by pyogenic organism (bacteria).
• The joint can become infected by : –

1. Hematogenous spread from a distant site (most common route).
2. Direct invasion through a penetrating wound, intrarticular injection, arthroscopy.
3. Direct spread from adjacent osteomyelitis especially in joints where Metaphysis is intraarticular e.g., hip and shoulder.

Organisms causing septic arthritis

•  Staphylococcus aureus is the most common cause of septic arthritis in all ages, although group-B streptococcus is also a common cause in newborns. H. influenzae was a common cause of septic arthritis in children but has now become rare due to the routine use of the conjugate vaccine. In young sexually active adolescents and adults two bacteria are commonly implicated.
• Staph aureus (non-gonococcal septic arthritis)
• Neisseria gonorrheae (gonococcal septic arthritis).

Clinical features

• Disease is more common in children. Knee joint is the most commonly affected joint. Other joint which are affected are hip, shoulder and elbow. The child is toxic with fever, tachycardia, tachypnea. There is severe pain, swelling, and redness over the joint. Movements are severely restricted and the joint is held in the position of ease. Weight bearing on limb is not possible.

Diagnosis and treatment

• Quickest and best method of diagnosis is aspiration of joint Gram staining and culture of aspirated fluid are done
• The treatment choice is surgery, i.e., arthrotomy & wash to the joint along with intravenous antibiotics.

Explanation:Ans. is ‘b’ i.e., Septic arthritis

Timing of surgery

• Fracture surgery can be divided into emergency, urgency or elective.

Emergency

• Emergency surgery is immediate for life and limb threatening problems. Examples are : –

1. Fracture or dislocation with vascular injury.
2. Fractures with compartment syndrome
3. Irreducible dislocation or fracture dislocation of major joint.
4. Compound (open) fractures
5. Septic arthritis
6. Spinal injuries with deteriorating neurological deficity.

Urgency

• Urgent surgery is the surgery, which should be done early (within 12-36 hours), but after arranging proper surgical facilities, Important examples are : –

1. Intra-articular fractures
2. Fracture neck femur
3. Fracture lateral condyle humerus in children.
4. Displaced supracondylar fracture humerus in children.

Elective

• Elective surgery is planned properly and can be done even after some delay (3-4 days to 3-4 weeks).
• Most of the surgeries in orthopaedics are elective. Example are : –

1. Closed fracture long bone
2. IT fracture
3. Most of the orthroscopic procedures
4. Arthroplasty

Explanation:Ans. is ‘c’ i.e., Markedly increased polymorphonuclear leukocytes

Appearance- Purulent
Clarity- Opaque
Viscocity- Decreased
Cell count- > 80000 (> 80% PMNs)
Example- Bacterial arthritis