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SOFT-TISSUE TUMOURS Soft-tissue tumours have also historically been classified according to their morphological appearance and presumed cell of origin. The range of biological behaviour is wide and most morphological types have a benign and malignant coun ter...

Staging of primary bone tumours In the Enneking system, benign tumours are staged as: /uni25CF latent (e.g. osteochondroma); /uni25CF active (e.g. osteoid osteoma); /uni25CF aggressive (e.g. giant cell tumour). covered incidentally . Active lesions, such as...

ACKNOWLEDGEMENTS Dr Philip Bejon and Dr Philipa Matthews contributed to earlier versions of this chapter, and I remain grateful for their input. ACKNOWLEDGEMENTS Dr Philip Bejon and Dr Philipa Matthews contributed to earlier versions of this chapter, and I r...

ACUTE OSTEOMYELITIS This presents like septic arthritis with a short history of pain, swelling, loss of function and systemic upset. In adults, the vertebral column is the commonest site; in children, long bones are most frequently a ff ected. In young childr...

ANTIMICROBIAL THERAPY FOR PROSTHETIC JOINT INFECTION AND FRACTURE-RELATED INFECTION Following surgical sampling, empiric broad-spectrum intra venous antibiotic therapy (e.g. vancomycin and meropenem) should be given. This can be rationalised when culture resul...

ANTIMICROBIAL THERAPY FOR PROSTHETIC JOINT INFECTION AND FRACTURE-RELATED INFECTION Following surgical sampling, empiric broad-spectrum intra venous antibiotic therapy (e.g. vancomycin and meropenem) should be given. This can be rationalised when culture resul...

Antibiotic therapy Patients with septic shock, or with rapidly advancing local or systemic signs of infection, should receive prompt empiric antibiotic therapy . When delay in antibiotics would be unsafe, blood cultures, local aspiration of pus or radiologic...

CHRONIC OSTEOMYELITIS This is a serious condition that may a ff ect the patient for decades. Chronic bone infection is best treated within a dedi - cated multidisciplinary team that has the skills to deal with all aspects of the condition, the associated com...

Clinical features Most patients present after an acute or subacute history with a single hot, swollen, painful joint. In children, there is often a history of recent minor trauma. The joint is held immobile in the ‘position of comfort’, with ‘pseudoparalysis’...

DIABETIC FOOT INFECTION The global prevalence of diabetes has increased exponentially in recent years. Foot infections are a leading cause of hospital admissions in this group, with an annual incidence of foot complications of 1–2% per year owing to the co...

Diagnosis Clinical - Diagnosis is predominantly clinical with confirmation using other tests, as outlined below . Biomarkers Raised inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and white cell count [WCC]) are characteristi...

EPIDEMIOLOGY The pattern of bone infection is changing, and the incidence is increasing. Bone and joint infection a ff ects around 1 per 10 /uni00A0 000 children across the world. Inadequate initial treatment generates chronic infections in up to one-third of ...

FRACTURE-RELATED INFECTION Infection complicates around 3–5% of all fracture fixations. Open tibia fractures are a high-risk group with up to 25% becoming infected after fixation. Calcaneal fractures and ankle fracture fixation in the elderly also have high infe...

FURTHER READING Coakley G, Mathews C, Field M et al . BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint. Rheumatology 2006; 54 : 1039–41. Dudareva M, Hotchen AJ, Ferguson J et al . The microbiology of osteomyelitis: changes ove...

GENERAL PRINCIPLES OF ORTHOPAEDIC INFECTION Pathology Bone infection has all the elements of any inflammatory condi tion but bone produces some specific pathological features. Acute osteomyelitis occurs when pathogenic organisms cause infection, leading to infla...

GENERAL PRINCIPLES OF ORTHOPAEDIC INFECTION Pathology Bone infection has all the elements of any inflammatory condi tion but bone produces some specific pathological features. Acute osteomyelitis occurs when pathogenic organisms cause infection, leading to infla...

INTRODUCTION Osteomyelitis is an old disease, identified in dinosaur bones, early hominids and skeletons from ancient civilisations. It is named from the components of the disease ( osteo , bone; marrow; itis , inflammation; Greek) and is caused by bacterial in...

Learning objectives To understand: Characteristic features of septic arthritis, acute and • chronic osteomyelitis and implant infections Diagnostic principles in bone and joint infection • Learning objectives To understand: Characteristic features of septic ar...