A PRACTICAL GUIDE TO THE DIAGNOSIS AND MANAGEMENT OF BONE AND JOINT INFECTIONS

Infectious arthritis arises from haematogenous spread of organisms thr ough the synovial membrane or from the direct extension of a contiguou s infection. The diagnosis rests on the isolation of the pathogen(s) f rom joint fluid obtained by aspiration or from debridement. Synovial f luid analysis and Gram stains provide clues to the aetiology. The trea tment of septic arthritis includes appropriate antimicrobial therapy a nd joint drainage. Bone infections are currently classified by the Wal dvogel or Cierny-Mader classifications. Cierny-Mader staging allows st ratification and development of comprehensive treatment guidelines for each stage. Osteomyelitis therapy emphasises early diagnosis and aggr essive treatment. Radiographs and bone cultures are the mainstays of d iagnosis. Radionuclide scans, computerised tomography or magnetic reso nance imaging may be obtained when the diagnosis of osteomyelitis is e quivocal or to help gauge the extent of the infection. Medical therapy includes improving any host deficiencies, initial antibiotic selectio n and antibiotic modification based on culture results. Surgical treat ment involves debridement of necrotic bone and tissue, obtaining appro priate cultures, managing dead space and, when necessary, obtaining bo ne stability.