Skeletal Tuberculosis
Infectious Orthopedics: Chronic Granulomatous Infection
1. Clinical Features
Tuberculosis of the bone is usually secondary to a primary pulmonary or lymphatic focus. It is insidious, chronic, and characterized by “cold abscesses” (lacking classic signs of acute inflammation like calor and rubor).
2. Most Common Sites
| Site | Clinical Pearl |
|---|---|
| Spine (Pott’s Disease) | Most common site. Involves the anterior vertebral body, leading to disc space narrowing and gibbus deformity (kyphosis). |
| Hip Joint | Second most common site. Presents with “painful limp,” limited range of motion, and potential for “wandering acetabulum.” |
| Knee Joint | Presents with synovial thickening and chronic effusion. |
3. High-Yield NEET Pearls
- Pott’s Spine (Tuberculous Spondylitis): The disc is affected early because of its vascular supply in children, unlike pyogenic osteomyelitis, where the disc is affected late.
- Gold Standard Diagnosis: Ultrasound-guided biopsy or open biopsy for histopathology (caseating granulomas) and culture (MGIT/BACTEC) or PCR.
- Radiology: Early findings show periarticular osteoporosis, soft tissue swelling, and “marginal erosions.” Later, look for the “abscess shadow” (e.g., psoas abscess).
- Treatment: Primarily medical with Anti-Tubercular Therapy (ATT). Surgery (debridement/stabilization) is reserved for neurological deficit, failure to respond to medication, or significant deformity.