Reports and commentaries on six cases illustrative of the diagnosis, treatment and management of tuberculosis of bone and joint

Abstract

As these cases are all of the one condition it would seem that a general commentary on the six cases as a whole would not be out of place.These cases illustrate well Various aspects of the the behaviour and treatment of tuberculosis of bone and joint in certain situations. There are certain sites of predilection for bone and joint tuberculosis and these are the spine (by quite a large percentage 50 in some series) the hip and the knee. Other sites e.g. shoulder, ankle and sacro-iliac joint are much less coin only affected. The above cases illustrate therefore a fair range of tuberculous disease including as they do the spine, the hip, the shoulder and sacro-iliac joint.The two cases of spinal tuberculosis illustrate the very earliest and the late stages of the disease. They demonstrate the difference in treatment at these two stages and also the fate of tuberculosis of the spine before chemotherapy. It is probable that if the early case of tuberculosis of the spine had occurred 20 years earlier she too would have ended in the same situation as the Pott's paraplegia which is described.A comparison of the cases of the disease in the hip joint is also very salutarT and again illustrates very well the fate of the condition before specific antibiotic therapy. The case of Richard Saunders also illustrates the difficulties of diagnosis of the condition and the importance of early diagnosis. The example of tuberculosis of the shoulder and sacro -diac joint illustrate the disease as it affects other joints and in these cases particularly the problem of complete cure even with chemotherapy.The differences in surgical management of tuberculosis in bone and hoint is demonstrated in the fact that in 3 of the cases (Hubert de Burgh,. Ann Laxwell, Isabelle Sandharn) the treatment is operative and involves major surgical interference at the site of the disease to clear the area of pus, debris and sequestra and also to carry out bone grafting. In one case, however, arthroplasty and not arthrodesis was required - this is generally much less common.The remaining three cases illustrate conservative treatment in the course of which biopsy and draining of an abcess was required (this does not change the fact that the treatment is conservative and not operative as these procedures might suggest).This also illustrates the change in the ideas about the surgical approach to the problem.