👉 Amritsar Call Girls 👉📞 8725944379 👉📞 Just📲 Call Ruhi Call Girl Near Me Amri...
Tuberculosis of bone and joints
1. TUBERCULOSIS OF BONES AND
JOINTS
Dr. Deepak Tyagi , junior resident,
Dept of orthopaedics
MGIMS,SEVAGRAM
2. .Tuberculosis is still a common infection in developing
countries . After lung and lymph nodes ,bone and
joint is the next common site of tuberculosis .
.It constitutes about 1-4 percent of the total number
of cases of tuberculosis.
.The spine is the commonest site of bone and joint
tuberculosis ,consisting about 50 % of the total
number of cases .
3. Etiopathogenesis:
• Common causative organism is
Mycobacterium tuberculosis.
• Skipped lesion
• Disseminated skeletal tuberculosis
• Types- caseative exudative and granular
• Atypical mycobacterial tuberculosis( M.
Kansasi)– synovial sheath.
Implant tuberculosis
• Healing
• Drug resistant tuberculosis
7. Investigations:
• Roentgenogram and X ray
chest
• Blood
• Sputum examination
• Synovial fluid analysis
• Mantoux test/ Tuberculin
test
• Guinea pig inoculation
• Smear and culture
• Isotope Scintigraphy
• Serological investigation/
interferon
• Modern imaging technique
( ultrasonography,CT,MRI)
8. Clinical features :
• Constitutional Symptoms :
• Localised symptoms and
signs:
• High index of suspicion
• Fallacious H/O trauma
9. Management :
• General treatment
• Care of the affected part
• Role of steroids
• Chemotherapy/ prophylaxis
• Middle path regime
• Local treatment and role of surgery
• Operative intervention :
10.
11. Operative intervention :
• Biopsy
• Treatment of cold abscess
• Curettage of the lesion
• Joint debridement
• Synovectomy
• Salvage operation
• Arthrodesis
• Joint replacement
• Decompression
• Osteotomy
• Amputation
• Ray resection
• excision
26. Operative treatment in TB spine
Absolute indications :
Paraplegia occurring during conservative treatment
Severe paraplegia
Paraplegia accompanied by uncontrolled spasticity
Relative indications:
Recurrent paraplegia
Paraplegia with onset in old age
Painful paraplegia
Rare indications:
Paraplegia due to posterior spinal disease
Spinal tumor syndrome
Severe paralysis secondary to the cervical disease
Severe cauda equina paralysis
54. Take home message
TB infection of the bone and joint causes chronic
pain ,deformity, disability and life threatening
especially in tuberculosis of cervical spine, hence
the diagnosis should be made early by keeping the
high suspicion index so that early treatment can be
started with the aim of healing of the disease and
getting good functional outcome by chemotherapy
alone or along with the surgical intervention
.Regular follow up is mandatory to achieve good
result