The module 2: surgical infection. Bases of clinical oncology. Curation of surgical patients. The thematic module 1

Surgical infection. Necrosis

Practical employment № 24

Theme: Purulent diseases of bones

І. Actuality of theme

Inflammation of bones was known a long ago. He is described in the works Hippocrates, Avitsenna, Tsel's, Galen and other Frequency of this disease among other purulent-inflammatory diseases is 2-3%. Among all of patients osteomyelitis 80-90% children make. There are lethal cases at this disease. Especially heavy flow of disease at acute hematogenous osteomyelitis (AHO) from dangerous complications, frequent passing to the chronic form, resulting in invalidization. At timely establishment of diagnosis, knowledge of clinical flow and correct treatment, prophylaxis and rehabilitation it is possible to prevent development of complications.

ІІ. Aims of employment:

1. To know anatomical and physiological features of structure of long tubular bone and feature of its blood supply (α=ІІ).

2. To know classification of osteomyelitis (α=ІІ).

3. To know etiology, pathologic anatomy, pathogeny (thromboembolic theory of Lekser and infectiously-allergic theory of Derizhanov), clinical signs and features of flow of different forms of osteomyelitis (α=ІІ).

4. To know the methods of rehabilitation at osteomyelitis (α=ІІ).

5. To capture the technique of methodical dosed percussion of bone at acute hematogenous osteomyelitis (AHO) (α=ІІІ).

6. Able to interpret sciagrams at the different forms of osteomyelitis (α=ІІІ).

7. Able to conduct differential diagnostics AHO with rheumatism, intermuscular phlegmon, fracture, erysipelas (α=ІІІ).

8. To capture the technique of interosseal punction with the purpose of diagnostics and treatment (α=ІІІ).

ІІІ. Providing of initial level of knowledges-abilities

Literature:

Basic:

1. Butyrsky A. General surgery. – Simferopol. 2004.

2. Gostishchev V.K. General surgery / The manual. – M.: GEOTAR-MED, 2003. – P. 164-170.

3. Shevchenko S.I. and others. Surgery. – Kharkov. 2004.

Additional:

1. Kushnir R.Lectures of General surgery. – 2005.

2. Methodological recommendations. – Vinnitsa National Pirogov Memorial medical university. 2007.

Interdisciplinary integration

Disciplines	To know	Able
1. Previous disciplines which provide
Anatomy	Anatomy of long tubular bone. Features of bone tissue for children. Features of red marrow for children
Physiology	Anatomic and physiological features of blood supply of long tubular bone and marrow for children
Pathophysiology	Signs of inflammatory process
Microbiology	Principles of conducting of microbiological research of punctate from bone and purulent excretions from bone and fistulas on microflora of determination of sensitiveness to the antibiotics	To conduct the fence of material for bacteriological research
Pharmacology	Antibiotics and antiseptics and methods of their application. Methods of intensive therapy and principles of disintoxicational therapy at acute hematogenous osteomyelitis (AHO)
2. Next disciplines which are provided
Child's surgery	Clinic, classification, treatment of AHO	To conduct clinical, laboratory, roentgenologic diagnostics; differential diagnostics of osteomyelitis with other inflammatory processes, breaks, ugly face, intermuscular phlegmon, dislocations and other
Traumatology and orthopaedy	Clinic of traumatic and firing osteomyelitis. Treatment and prophylaxis. Chronic osteomyelitis, treatment. Chronic osteomyelitis (abscess Brodie, albuminous Ollje, sclerosed Garre). Clinic, treatment	To conduct clinical, laboratory, roentgenologic diagnostics and differential diagnostics of osteomyelitis with other inflammatory processes, breaks, ugly face, intermuscular phlegmon, dislocations and other
Infectious diseases	Clinic of different forms of osteomyelitis	To conduct differential diagnostics with an erysipelas
Radio-therapy	Features of sciagrams at osteomyelitis	To interpret sciagrams at osteomyelitis
3. Intradisciplinary integration
Desmurgia	Soft and hardenings bandages	To impose a bandage and gipseous bandage on a shin, thigh, shoulder and other
Studies about wound process	Phases of flow of wound process at traumatic, firing osteomyelitis and fistulas	To distinguish phases of flow of wound process
Antisepsis	Antiseptics for local application at a needle biopsy of bone, traumatic and firing osteomyelitis, fistulas	To choose preparation depending on the phase of flow of the infected wound of skin or bone
Anaesthesiology	Method of anaesthetizing at operations at osteomyelitis	To choose the adequate method of anaesthetizing

Tests for verification of initial level of knowledges

1. In what age more frequent acute hematogenous osteomyelitis develops?

а) 1-10 years (+);

b) 11-20 (+);

c) 21-30;

d) 31-40;

e) 41-50.

2. What bones more frequent are struck at hematogenous osteomyelitis?

а) femoral (+);

b) sciatic;

c) vertebrae;

d) tibial (+);

e) humeral.

3. The characteristic sign of what types of osteomyelitis sequestration of bone is?

а) abscess Brodie;

b) posttraumatic osteomyelitis (+);

c) Ollje osteomyelitis;

d) Garre osteomyelitis;

e) hematogenous osteomyelitis (+).

4. Name the distinctive signs of abscess Brodie:

а) cavity with sequestra;

b) cavity without sequestra (+);

c) mucous exudatum;

d) purulent exudatum (+);

e) diffuse osteosclerosis.

5. Name the distinctive signs of Garre osteomyelitis:

а) cavity in metaphysis;

b) bulge of bone (+);

c) presence of sequestra;

d) albumen exudatum;

e) osteosclerosis (+).

6. When the roentgenologic signs of acute hematogenous osteomyelitis appear?

а) in 3 days;

b) in 3 months;

c) in 10-15 days (+);

d) in 20-30 days;

e) in 30-40 days.

7. What basic signs of chronic hematogenous osteomyelitis?

а) atrophy of muscles;

b) osteoporosis;

c) presence of purulent fistula (+);

d) presence of sequestral box and sequestrum in her (+);

e) presence of cavity without sequestra.

8. For chronic hematogenous osteomyelitis are not characteristic:

а) frequent defeat of metaphysis and epiphysis tubular bones (+);

b) frequent defeat of diaphysis tubular bones;

c) rarely meeting atrophy of muscles;

d) the constantly observed atrophy of muscles (+);

e) rare defeat of the nearest joints.

9. What pathological changes are not observed at acute hematogenous osteomyelitis:

а) phlegmon of marrow;

b) subperiosteum abscess;

c) formation of cavity without sequestra (+);

d) paraossal and intermuscular phlegmon;

e) albumen exudatum (+).

10. What from the transferred microorganisms can not become the etiologic factor of origin of osteomyelitis?

а) intestinal stick;

b) staphylococcus;

c) stick of tetanus (+);

d) the diphtherial stick of Leffler (+);

e) protey.

11. What local clinical displays testify to the neglected cases of acute hematogenous osteomyelitis?

а) going of skin pale;

b) deformation of bone;

c) appearance of symptom of fluctuation (+);

d) formation of skin necrosis area;

e) formation of purulent fistula (+)

12. What surgical receptions are most expedient at medical treatment of patient with acute hematogenous osteomyelitis?

а) only dissection of phlegmon;

b) dissection of phlegmon and section of periosteum (+);

c) resection of the staggered bone;

d) decompressive drainage of bone channel (+);

e) amputation of extremity.

13. What methods are most effective during sanation of bone cavity after radical sequestrectomy?

а) seal integrity by a gypsum;

b) myoplastic (+);

c) tamping;

d) the plastic arts by a collagen sponge with antiseptics (+);

e) seal integrity by a hypodermic fatty cellulose.

14. What medical measures are contra-indicated in the early stage of acute hematogenous osteomyelitis?

а) massage (+);

b) medical physical education (+);

c) creation of functional rest of the staggered region;

d) introduction of antibiotics;

e) setting of bacteriophage.

15. The most frequent complications at protractedly current chronic osteomyelitis:

а) cirrhosis of liver;

b) amiloidosis of buds (+);

c) endocarditis;

d) dystrophy of myocardium;

e) chronic anaemia (+).