askep osteomielitis – Fakultas Keperawatan – Read more about osteomyelitis, tissue, chronic, debridement, staphylococcus and aureus. ASKEP OSTEOMIELITIS. FN. Farid Nugroho. Updated 30 December Transcript. NIC. ASKEP 3. PENGKAJIAN. NOC. NIC. NOC. ASKEP 2. Twelve children, aged years at presentation, diagnosed with pyogenic osteomyelitis of the forearm bones, were reviewed retrospectively. The radius was.
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Pyogenic osteomyelitis of the forearm bones in children. Twelve children, aged years at presentation, diagnosed with pyogenic osteomyelitis of the forearm ostdomyelitis, were reviewed retrospectively. The radius was involved in six patients, the ulna in five and both bones in one child. Three children had acute osteomyelitis; the remaining nine had features of chronic osteomyelitis.
The acute infections had incision and drainage and healed well. In six patients with chronic osteomyelitis treatment involved curettage, debridement and sequestrectomy, with resulting bone defects.
Three children with chronic infection were referred with established defects from outlying hospitals. Two children with distal ulna resorption had radioulnar synostosis. Two children had radial club hand deformity with loss of the radial shaft.
One had transposition of the residual metaphysis of the radius to the distal ulna, and the other had oeteomyelitis of the carpus to the ulna. The remaining child had shortening of the radius following multifocal osteomyelitis in infancy. All reconstructive procedures healed by 3 months. All children had improved function.
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Shortening of the forearm ranged from cm. Osteomyelitis, forearm bones, radial club hand, radio-ulnar synostosis. In infants, the forearm involvement may be a manifestation of a multifocal infection. The acute infection presents with fever, pain, swelling, pseudoparalysis and occasionally, a compartment syndrome.
Although cure rates have improved due to early detection and improved antibiotics, the diagnosis is not always obvious and may be delayed. Chronicity may occur resulting in a pathological fracture, sequestrum formation, discharging sinuses and pseudarthrosis. Weakness of grip, shortening and a cosmetic deformity are complications which occur later due to continuing growth of the intact bone.
Osteomyelitis of the radius with a large defect can result in overgrowth of osetomyelitis ulna resulting in dislocation of the distal radioulnar joint, radial deviation of the hand and weakness of grip. Radial club hand type of deformity may occur with extensive defects.
Defects of the ulna shaft can result in curvature of the intact radius and consequent dislocation of the radial head resulting in instability of the elbow and a cosmetic deformity.
Various methods have been used to reconstruct the forearm. These include cancellous bone grafting 4,7 and strut grafts for shaft defects, oseomyelitis synostosis for larger defects with joint involvement and carpal transposition to the ulna for radial club hand type deformity. This is mainly a descriptive account of the experience with pyogenic osteomyelitis of the radius and ulna.
Twelve children, aged years of age at first presentation, were reviewed retrospectively between and osheomyelitis a local hospital Table I. Two infants were younger than a year at the time of primary infection. The remaining nine children were seen later, after two weeks, with established signs of chronic infection. The majority were boys and the dominant side was involved in seven patients.
Staphylococcus aureus was confirmed on pus swabs as the causative organism in all patients. The radius was involved in six children and the ulna in five.
One child had both bones involved.
Pyogenic osteomyelitis of the forearm bones in children
In the patients with chronic osteomyelitis, gap defects with sequestra were seen in two patients and two others had large sequestra with bone defects of cm. Destruction of the entire ulna distal to the olecranon was seen in two patients: These two patients also had radial head dislocation Figure 1a. Destruction of the radial shaft was seen in one patient. The metaphysis remained intact and he presented with a radial clubhandlike deformity Figures 2a and 2b.
Another child with a similar deformity had infection in the neonatal period and presented with a stunted ulna and a small proximal radius with marked shortening Figure 3a. There was a history of drip infiltration, followed by incision and drainage in infancy. The remaining child presented with a short radius. He had a history of incision and drainage of the femur and tibia treated in infancy. The three patients with acute osteomyelitis underwent early incision and drainage Table I.
One had proximal radial involvement and required fasciotomy of the forearm for early compartment syndrome. He required skin grafting and healed.
The remaining two had distal radial involvement and pus was found deep to the pronator quadratus muscle at surgical exploration. Reviewing the nine patients with chronic osteomyelitis, one child with multifocal bone involvement in infancy had decreased growth of the radial shaft resulting in 4 cm shortening of the forearm and radial deviation of the wrist.
Regarding the remaining eight patients, two children had established bone defects, and six underwent surgery with debridement of granulation tissue, sequestrectomy and curettage of the bone ends. Three had insertion of antibiotic beads in the bone defect following sequestrectomy.
Reconstruction was performed when the infection healed. Two with defects of cm, had segmented bone grafts 1. All grafts were taken from the iliac crest. The two children with resorption of the ulna distal to the olecranon had transposition of the radial shaft to the proximal ulna through a defect in the interosseous membrane to create a onebone forearm. A 2 mm K wire was used to transfix the cut ends Figures 1b and 1c.
The resected proximal radius was used as bone graft around the synostosis site, following its subperiosteal removal. One child with the radial club hand deformity had transference of the radial metaphysis to the distal ulna following resection of the styloid Figure 2c and the other had transfer of the whole carpus to the distal ulna Figure 3b. Both were fixed with K wires. The wrist was kept in a neutral position in all transfers.
All three patients with acute pyogenic osteomyelitis of The radius healed well without radiological defects following incision and drainage Table I. Two children with bicortical iliac crest segments over a K wire showed good union by six weeks when the K wires were removed.
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One patient was lost to followup after 12 weeks. The two patients who had transposition of the distal radial shaft to the proximal ulna developed a good radioulnar synostosis. The wires were removed at 8 weeks. One child with radial metaphyseal osteomyelitos to the ulna for radial club hand had a stable wrist after 6 weeks and at 1 year the physis remained open Figure 2c.
The other patient with radial club hand deformity, had shortening of 20 cm due to growth arrest of the radius and ulna in infancy. The wrist was stable following carpal transposition to the ulna. The metacarpophalangeal joints remained stiff. However, mobility of the interphalangeal joints and thumb resulted in a weak but useful grip Figure 3b. The children with radioulnar transposition and radiocarpal transfer compensated for loss of elbow rotation with adequate rotation of the shoulder joint.
One child with multifocal osteomyelitis in infancy had a shortened radius 4 cm at followup, with a prominent ulna styloid and radial deviation of the carpus. He had adequate wrist function and grip and did not want further treatment. Followup ranged from 4 months to 14 years. Shortening was between 2 cm and 20 cm in eight children. Primary haematogenous osteomyelitis in growing bone is still a major challenge despite advancements in treatment.
Osteomywlitis the forearm infection may be part of a multifocal sepsis and may manifest later with a cosmetic deformity due to growth disturbance. The acute infection is commonly due to Staphylococcus aureus and starts osteomyeiltis the metaphysis of the radius or the ulna. Pus may be located deep to muscle as seen in cases 2 and 3.
Primary epiphyseal involvement has also been reported. In the chronic stage, osteomyelitis of the ulna or radius may be associated with pathological fracture, sequestrum formation, cavities and sinuses.
Bone deficiency may occur following resorption, extrusion of sequestra or following surgical removal. The bone defects may be small or extensive. Longterm effects occur with growth arrest and deforming forces, resulting in cosmetic deformity. Unequal growth results in joint instability at either end.
The ulna may angulate with growth, resulting in an acquired radial club hand deformity. Deficiency of the proximal radius results in a askeo valgus deformity and curvature of the ulna. Defects in the ulna mainly occur distal to the olecranon. The proximal interosseous membrane and annular ligament may become deficient following bone infection. Ulna deviation occurs at the wrist. The stability provided by the ulna at the elbow and at the wrist by the radius is lost and stress is transmitted from the radius to the ulna.
Unimpaired radial growth results in dislocation of the radial head. Posterior interosseous palsy may result. The treatment of the bone defects following pyogenic osteomyelitis is challenging. Primary diaphysectomy was a favoured operation osteomyslitis a lifesaving or curative procedure prior to antibiotics. However, most surgeons opposed it because of the complex reconstructive problems which followed failure of bone regeneration. Restoration of bony continuity following pyogenic osteomyelitis of the forearm with defects is difficult.
A high rate of complications and low union rates have osteo,yelitis reported. Spontaneous regeneration of segmental gap defects have been reported in osteomyelitis due to compound fractures of the radial shaft. However, in cases seen in this study the periosteal tube was destroyed in the infective process. There was some continuity of periosteum of the ulna which formed a useful bed for incorporation of bone graft.