It is now virtually certain that the brittle bone syndrome results from a variety of mutations in the alpha chains of type I collagen. Whilst the increasing biochemical knowledge makes prenatal diagnosis sometimes possible, the care of those with severe physical disability still provides a clinical challenge which is not always met. Future research in this disease therefore needs to be clinical as well as biochemical.
Most of the data for this paper were taken from a 30-year follow-up of septic arthritis and a 25 year series of osteomyelitis seen in Dallas, Texas. A specific bacterial aetiology was determined in about 70% of patients with septic arthritis, utilizing culture of multiple fluids. The aetiological agent was influenced by the age of the patient. In the newborn Staph. aureus, group B streptococci and gram-negative organisms are found most commonly. In the older infant H. influenzae becomes a prominent pathogen, and in those over 2 years of age staphylococci, streptococci, H. influenzae and N. gonorrhoea are the predominant organisms. Ninety-three per cent of arthritis was monoarticular. A slightly higher percentage (78%) of children with osteomyelitis had a specific bacterial aetiology determined. Staph. aureus was the most common pathogen found at all ages, averaging 53% of all cases and in all age groups, and followed in frequency by various types of streptococci. Diagnosis was delayed in osteomyelitis compared to septic arthritis. In the Dallas patients a single bone was involved in 316 compared to 24 with polyosteal disease. In both infections the initial antibiotic chosen is determined by the gram strain of material obtained from joint aspiration, pus, or other secretions. If no specific bacterial aetiology is found, treatment is begun for the most likely organism considering the age of the patient and the clinical situation. Recently oral therapy has been used extensively in specific instances after an initial period of parenteral therapy. A limited number of follow-up studies have shown that the age of the patient, the bone and/or joint involved, and the organism responsible all influence the long-term results in both septic arthritis and osteomyelitis. The poorest long-term prognosis is in the neonate, especially where the hip joint is involved either alone or with a concomitant osteomyelitis.
Acute infectious arthritis remains a clinical emergency where early diagnosis and appropriate therapy are essential to a successful outcome. The therapeutic requirements for a successful outcome include early diagnosis, appropriate antibiotics, joint mobilization and adequate drainage. The method of drainage can be medical with needle aspiration or surgical with arthroscopic or open surgical debridement. The literature review presented in this chapter supports the value of the initial use of medical therapy in the management of the acutely infected joint, with surgical drainage reserved for failure of medical management or for initial drainage of hip infections where needle aspiration is difficult.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：