This condition can last from three to twelve weeks, but it is also reversible and goes away completely if proper treatment is carried out in time.

When ossification of the entire periosteal layer occurs, its shadow completely merges with the shadow of the cortex.

Syphilis of the skeletal system can begin at any time during the course of the infection. But at each stage, bone lesions will develop completely differently. This means that they will also differ initial symptoms, and the nature of the disease.

Bone lesions in the secondary period of acquired syphilis are also rare and account for 0.5-3%. In this case, periostitis is observed, without the formation of typical gummas.

“Olympic forehead” - due to enlargement of the frontal and parietal tubercles.

The “saddle nose” in congenital syphilis is not explained by the formation of gummas that destroy the nasal bones, but by the resorption of the nasal septum as a result of a long-term specific process in the mucous membrane, leading to atrophy of the nasal cartilage.

Osteochondritis goes through 3 stages in its development. In stage 1, increased deposition of lime occurs in the pre-calcification zone (it increases to 1.5-2.5 mm). In stage 2, along with a wide calcified zone, a narrow strip of granulation tissue is formed, located between the metaphysis and the calcification zone. In the calcification zone, multiple small notches appear, facing the epiphysis. This jagged line towards the epiphysis and the emerging band of clearing are the most typical signs of osteochondritis. At stage 3, the strip of granulation tissue expands. The granulations also destroy the cortical substance, grow towards the diaphysis, and also dissolve the zone of preliminary calcification so that its calcified marginal part, undermined on all sides by the granulations, freely sticks out to the side.

In bone tuberculosis, the epiphysis is a typical location. Children under the age of five are most often affected. The focus of destruction is not accompanied by a sclerotic reaction and spreads without clear boundaries to the adjacent osteoporotic area of ​​the bone. There is almost always sequestration in the form of “melting sugar”. There is no periostitis.

How common is syphilis of the skeletal system?

In primary syphlis, bones are rarely affected; There are only isolated reports of periostitis with chancre.

Epimetaphyseal periostitis always accompanies severe syphilitic osteochondritis. In this section, the periosteal reaction is less pronounced. The calcified shell surrounding the peripheral third of the bone has the shape of a half-spindle, the narrow part merges with the diaphysis.

Destructive-proliferative (gummy) processes can be located subperiosteally, intracortically, and less commonly in the bone marrow. Syphilitic gumma in the initial stages of development is an inflammatory node with decay in the center. Intense formation of osteosclerosis occurs around the gummous lesion.

In the tertiary period, according to the literature of previous years, bone damage is one of the private symptoms, observed in 20-30% of patients and is in second place in frequency after damage to the skin and mucous membranes. Due to the sharp decrease in advanced forms of syphilis, bone lesions are now not common (periostitis, specific osteomyelitis).

Differential diagnosis must be made with nonspecific osteomyelitis and bone tuberculosis.

Gummous periostitis is observed in favorite place, in the diaphysis (usually the tibia) - in the ossified periosteum one or more oval or round gummas are determined. Radiographs usually show limited bone thickening in the shape of a half-spindle at the level of the diaphysis due to thickening of the periosteum with a smooth outer contour. Gumma - one or several in the form of a focus of destruction (no more than 1.5-2 cm in size) is located in the very central place of the osteophyte, directly under the periosteum, with clear sclerotic contours.

Periostitis in early congenital syphilis is very common and can be combined with osteochondritis. On radiographs, periostitis appears as a more or less wide ossified strip located parallel to the length of the bone. Very fresh periostitis, when there are only proliferative changes, remain invisible on radiographs. The first radiological symptoms of inflammation of the periosteum appear only with calcification of the periosteal layers. The superficial one ossifies first.

We will tell you how bone syphilis first appears at each stage of the general disease.

Joint damage:

Intoxication is accompanied temperature rise And aches in the body, including in joints and bones. This condition is completely reversible and even goes away on its own after 1-5 days.

When the connection between the epiphysis and metaphysis is completely disrupted, an intrametaphyseal bone fracture is formed. Clinically, these fractures are designated as pseudoparalysis or Parrot's palsy - the limb near the joint is swollen, painful, and the muscles are flabby. The lower limbs are usually contracted, and the upper limbs are flaccid and lie motionless.

Bone syphilis: in what period does it begin?

“Buttock-shaped skull” is a sharp protrusion of the frontal and parietal tubercles with a depression located between them, which gives the skull the appearance of a buttock. (Before the age of 10-12 months and even in intrauterine life, diffuse syphilitic osteoperiostitis develops in the frontal and parietal bones).

In the tertiary period, damage to the skeletal system develops more often - in 20-30% of cases. As a rule, at this stage the bones suffer much more and the joints suffer less. With late syphilis, a person begins to experience irreversible bone and joint deformations, which significantly reduce the patient’s quality of life.

Some bone defects can then be repaired surgically. But, unfortunately, medicine is not omnipotent, and it is important to understand that some violations will be impossible to correct.

Syphilitic osteomyelitis. Multiple gummy osteitis, when gummas are located at different depths, has the character of gummy osteomyelitis, most often localized in the diaphysis. Processes localized in the diaphysis, metaphysis or epiphysis have their own characteristics. The syphilitic process in the diaphysis is accompanied by a violent endosteal reaction, and massive reactive sclerosis is observed around the gummas. The gummous process in the metaphysis has some features of the diaphyseal, but the endosteal and periosteal reaction is less pronounced. The process does not pass into the epiphysis through the germinal cartilage. Syphilitic epiphysitis occurs in the form of single gummas. In late congenital syphilis they are rare. A focus of destruction with mild sclerosis and slight periostitis is determined.

A diffuse and gummous process can be located in any part of the bone - in the periosteum, in the cortex, spongy substance or in the bone marrow. There are osteoperiostitis and osteomyelitis.

In the tertiary period, bone syphilis begins with the so-called gummous process - it manifests itself as the formation of cones, and then their destruction in any part of the body, including in joints or bones.

Garre's osteomyelitis affects the diaphysis. There are no foci of destruction. The bone is thickened in the form of a regular spindle with smooth outer contours. With syphilis there may be foci of destruction; osteoperiostitis does not have such a regular spindle shape, its outer contours are slightly wavy.

Based on localization, there are 2 types of periostitis in early congenital syphilis - diaphyseal and epimetaphyseal.

Diaphyseal periostitis in the form of a sleeve or case covers the entire diaphysis. The outer contours of the calcified periosteum in congenital syphilis are smooth and clear. Sometimes periostitis is a manifestation of a reactive process during diaphyseal gummous destructive changes in the bones.

pain in bones and joints;

Nonspecific osteomyelitis is localized in the metaphysis. If with syphilis the processes of bone creation prevail, and with tuberculosis - destruction, then with osteomyelitis these processes are combined. Sequestration almost always occurs. Clinical manifestations and laboratory data should be taken into account.

With early congenital syphilis, damage to the phalanges is noted. Syphilitic phalangitis most often affects the upper extremities, less often the lower, mainly the main phalanges. The lesion is bilateral, but not symmetrical. Characteristically, there is a pronounced periosteal reaction in the form of a bone coupling around the phalanges, which are thickened in the form of a barrel. Their structure is compacted; against the background of sclerosis, there may be foci of destruction due to

With late congenital syphilis, multiplicity and symmetry of the process are less common.

Damage to bones and joints due to syphilis

It becomes more difficult for the patient to move the affected joints.

osteoperiostitis - inflammation of the periosteum and bone tissue;

Depending on the stage to which “general” syphilis has reached, the risk of developing bone syphilis will vary.

At the end of the primary period, aches and pains in joints and bones develop in approximately 20% of patients. Such symptoms are noted in every fifth patient.

Secondary period

With late congenital syphilis, bone changes occur much more often than with secondary and tertiary acquired syphilis, but less often than with early congenital syphilis and are observed in approximately 40% of patients. The tibia, bones of the nose and palate, and skull bones are affected.

Syphilis is a sexually transmitted disease caused by the spirochete pallidum. There are acquired and congenital syphilis. During acquired syphilis, there are 3 periods: 1. Primary. 2. Secondary. 3. Tertiary. Congenital syphilis is divided into early - before 1 year and late - after 4-5 years and up to 16 years. The skeletal system can be affected in all periods of acquired syphilis.

Additional symptoms of early congenital syphilis: “Olympic forehead”, “Buttock-shaped skull”, “Saddle nose”.

the temperature rises;

The onset of syphilis of bones and joints in the secondary period is, first of all, inflammation caused by a general syphilitic infection.

With late congenital syphilis, dental dystrophy is observed, most often the two upper middle incisors. Atrophy of the chewing surface is pronounced, as a result of which the neck is wider than the cutting edge. There may be a semilunar notch on the cutting edge. This symptom is pathognomonic for late congenital syphilis (Hutchinson, 1856).

Joint structure

Differential diagnosis has to be carried out with rickets, tuberculosis and childhood scurvy.

Diffuse syphilitic osteoperiostitis with late congenital syphilis takes 1st place in the frequency of lesions. The tibia is predominantly affected. On radiographs, the thickened, ossified periosteum merges with the cortex. In all layers of the bone there is massive sclerosis, the bone loses its structure over a large area. The outer contour is clear, but may be somewhat wavy. Among the sclerosis, pockets of destruction due to milliary gummas can be observed - this is a combination of multiple gummous and diffuse syphilitic periostitis.

Differential diagnosis should be made with osteoid osteoma.

(specific osteomyelitis)

X-ray - tender club-shaped layers in the epimetaphyses of long tubular bones can be combined with intrametaphyseal fractures. It is necessary to take into account the clinic, anamnestic and serological data.

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syphilitic arthralgia is pain in the joints, but without inflammation or destruction of the cartilage and bone tissue of the joint;

X-ray picture: the focus of destruction is elongated or round in shape with reactive osteosclerosis. Multiple syphilitic gummas can be milliary, subbiliary or significant in size. When they merge, continuous syphilitic granulation tissue is formed - multiple foci of destruction located in a limited area, having clear contours with a rim of sclerosis. Syphilitic osteomyelitis develops in the presence of a secondary pyogenic infection. Syphilitic gummas are very rarely complicated by suppuration with the formation of sequestration and fistulous tracts. Only mixed infection leads to significant bone sequestration.

Infantile scurvy most often appears between the ages of 7 and 15 months. The disease is manifested by increased fragility of blood vessels and subperiosteal hemorrhages. Hematomas peel off the periosteum, and during the repair stage they are impregnated with lime salts.

Syphilitic damage to the skeletal system can be divided into two large groups: joint damage and bone damage. Let's take a closer look at them.

In this case, a person begins to:

Gummous (focal destructive process) with early congenital syphilis is not often observed. It is localized mainly in the ulna and tibia, as well as in flat bones. Changes can be observed in the metaphysis, in the diaphysis, located subperiosteally and in the bone marrow. Changes can be single or multiple. Their diameter is 0.2 to 0.8 cm. On radiographs, isolated foci of destruction have an oval or round shape, surrounded by a zone of osteosclerosis.

people with secondary syphilis suffer from bone lesions

layer of periosteum.

Typically, syphilitic lesions spread from the outside to the inside (from the periosteum to the center of the bone, bone marrow). The deeper the destructive process penetrates, the more severe its consequences can be.

With specific osteochondritis, changes occur both in the cartilage of the epiphysis and in the bone tissue of the metaphysis. These changes occur during the period from 5 months of intrauterine life to 12 months after birth. After 1 year, osteochondritis occurs as a rare phenomenon, and after 16 months, it is not observed at all.

Gummous changes occur mainly in tertiary acquired syphilis. With early congenital syphilis, both forms of bone tissue damage can occur.

Tertiary period

• syphilitic arthritis is inflammation of the joints, which in turn are divided into: primary synovial, or synovitis (inflammation of the joint capsule and joint capsule) and primary bone, or osteoarthritis (when inflammation from the bone passes to the joint).

With this course, syphilis of the bones brings great suffering to the patient, and can cause deformity and even disability.

Rickets is characterized by diffuse osteoporosis of long tubular bones, a periosteal reaction of the fringe type is possible, and pathological fractures of the “greenstick” type are observed. Cup-shaped deformation of the metaphyses of tubular bones is characteristic. There are no foci of destruction.

• osteomyelitis - damage to the spongy bone and bone marrow.

Syphilitic osteoperiostitis is of two types - gummous and diffuse.

Pain and aches are a fairly common signal that primary syphilis has become secondary.

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Syphilis of the bones can already very early after infection (after about 6 weeks) cause very severe periosteal pain (skull, ribs, sternum, tibia). Severe night pain in the tibia is almost pathognomonic and can be compared in nature and distribution only with pain during Volyn fever.

Clinical and radiological data in the early stages they contribute little to establishing a diagnosis; Of decisive importance is the Wasserman reaction and the rapid effect of antisyphilitic treatment.

Syphilis of the bones tertiary period and congenital syphilis with saber-shaped shins and radiologically established destruction of the bone structure and involvement of the periosteum are now rare (Wassermann reaction!)

Fungal infections- actinomycosis, blastomycosis, coccidioidomycosis (in the USA) - are localized in the bones with increasing frequency, but in the clinical picture pulmonary and skin manifestations almost always come to the fore.

Occupational bone necrosis observed in those working with compressed air and in caisson work. In the former, fractures play a major role, in the latter, air embolisms, which lead to circulatory disorders.

Overload fractures occur when there is excessive (often unusual) load on the skeletal system.
Most Fractures of the metatarsal bones in soldiers are known (so-called marching fractures).

Multiple bone lesions.

With multiple bone lesions and diffuse changes in bones (osteoporosis, osteosclerosis) in adults, you should always remember that often we're talking about not about local bone disease itself, but about secondary changes in bones due to some general disease.

With appropriate changes in bones Therefore, a biochemical blood test should always be performed to determine the content of total protein, calcium, phosphorus and phosphatase. The results of these studies can be decisive for the diagnosis. Hyperglobulin m and I speaks in favor of myeloma, hypercalcemia (with a decrease in phosphates) is characteristic of primary hyperparathyroidism (Recklinghausen's osteitis fibrosa) or (with an increase in phosphates) - for secondary hyperparathyroidism. Elevated alkaline phosphatase levels are suggestive of osteomalacia, osteitis fibrosa, Paget's disease, or bone metastases.

Mostly multiple limited bony lesions in adults with more or less severe bone pain are observed with:
a) inflammatory lesions x: osteomyelitis, tuberculosis, syphilis, fungal lesions, sarcoidosis;
b) tumors: myeloma, primary bone marrow tumors;
c) bone metastases: lymphogranulomatosis, hemangioma;
d) storage diseases: Gaucher disease, Niemann-Pick disease, Hand-Schüller-Christian disease.

Possibly rare eosinophilic granuloma, first described by Fraser (1935), is only a particularly benign form of Schüller-Christian disease. Accordingly, eosinophilic granuloma should be considered as a partial manifestation of Schüller-Christian disease. Here, too, non-sharply defined bone defects in the ribs or other flat bones are pathognomonic. The lesions can be single or multiple. The disease develops mainly in adolescence (however, cases of the disease are described up to the 5th decade of life) and, as a rule, begins suddenly with bone pain and swelling, intensifying over the course of weeks.

Observed low-grade fever. There is slight eosinophilia in the blood (up to 10%), but in general the blood picture is not typical.
The diagnosis can only be accurately established after trial excision, although the clinical picture is quite typical. The disease then progresses rapidly and good effect radiation therapy.

The content of the article

Etiologists and pathogenesis of syphilitic osteomyelitis

The disease occurs as a chronic inflammatory process with gummous bone lesions.

Clinic of syphilitic osteomyelitis

There is chronic inflammation with a characteristic localization in the bones of the nose, the central part of the palatine processes of the upper jaw, the alveolar process in the area of ​​the upper frontal teeth, much less often the lower jaw and zygomatic bone. Great importance When making a diagnosis, they acquire data from anamnesis, Wasserman or Kahn reactions, differential diagnosis with odontogenic osteomyelitis, and a malignant tumor.
Along with destructive processes, there are sclerotic changes both around the areas of destruction and at a distance from them. Typically, lesions of the jaws are combined with lesions of other bones. The radiograph clearly shows the focus of destruction, surrounded by a dense sclerotic shaft. The lower jaw is affected in the area of ​​the angle or body. Sclerotic changes are not so clearly visible, so it is quite difficult to differentiate isolated lesions of the lower jaw from hematogenous osteomyelitis or a tumor process. The alveolar processes are affected secondarily as a result of the transition of the process from the oral mucosa. An intraoral radiograph reveals marginal destruction.

Treatment of syphilitic osteomyelitis

Treatment comes down to specific therapy for syphilis. If indicated, sequestrectomy is performed.
The prognosis is relatively good.

The most complete answers to questions on the topic: “syphilis of bones and joints.”

Syphilis of bones and joints is a common manifestation of the underlying disease, especially if it has been going on for a long time. In all its manifestations, syphilis of the skeletal system is directly related to the general infection - to how it proceeds and affects the body. This means that diseases of the skeletal system with syphilis depend on the period of the underlying disease and can be expressed in different ways: from mild pain in the joints and bones to their severe damage. The latter option is especially dangerous - without treatment, bone syphilis can lead to partial or complete paralysis of the patient, deformities of bones and joints.

In this article we tell you all the most important things about bone syphilis: how it begins and progresses, how it is diagnosed and treated, and how likely it is that the skeletal system will be affected in a patient with syphilis.

1. Bone syphilis: in what period does it begin?
2. How syphilis damages the skeletal system
3. How often does syphilis of the skeletal system occur?
4. Symptoms of syphilis of bones and joints at different stages
5. Secondary bone lesions
6. How is syphilis of bones and joints diagnosed?
7. Treatment of syphilis of bones and joints

Bone syphilis: in what period does it begin?

Syphilis of the skeletal system can begin at any time during the course of the infection. But at each stage, bone lesions will develop completely differently. This means that both the initial symptoms and the nature of the disease will differ.

We will tell you how bone syphilis first appears at each stage of the general disease.

Primary period

Cause initial signs bone lesions in the primary period of syphilis - general intoxication body. It occurs when syphilis bacteria “en masse” enter the bloodstream, spread throughout the body and poison it with the products of their vital activity. This occurs at the end of the primary period.

Intoxication is accompanied temperature rise And aches in the body, including in joints and bones. This condition is completely reversible and even goes away on its own after 1-5 days.

Secondary period

The onset of syphilis of bones and joints in the secondary period is, first of all, inflammation caused by a general syphilitic infection.

In this case, a person begins to:

• pain in bones and joints;
• the temperature rises;
• It becomes more difficult for the patient to move the affected joints.

This condition can last from three to twelve weeks, but it is also reversible and goes away completely if proper treatment is carried out in time.

Tertiary period

In the tertiary period, bone syphilis begins with the so-called gummous process - it manifests itself as the formation of cones, and then their destruction in any part of the body, including in joints or bones.

With this course, syphilis of the bones brings great suffering to the patient, and can cause deformity and even disability.

Tertiary syphilis of bones is irreversible, but if proper treatment is carried out, the destruction of the skeletal system can be stopped

Some bone defects can then be repaired surgically. But, unfortunately, medicine is not omnipotent, and it is important to understand that some violations will be impossible to correct.

How syphilis damages the skeletal system

Syphilitic damage to the skeletal system can be divided into two large groups: joint damage and bone damage. Let's take a closer look at them.

Joint damage:

Joint structure

1. syphilitic arthralgia is pain in the joints, but without inflammation or destruction of the cartilage and bone tissue of the joint;
2. syphilitic arthritis is inflammation of the joints, which in turn are divided into: primary synovial, or synovitis (inflammation of the joint capsule and joint capsule) and primary bone, or osteoarthritis (when inflammation from the bone passes to the joint).

Bone lesions:

1. periostitis - inflammation of the periosteum (connective tissue covering the bone);
2. osteoperiostitis - inflammation of the periosteum and bone tissue;
3. osteomyelitis - damage to the spongy bone and bone marrow.

Typically, syphilitic lesions spread from the outside to the inside (from the periosteum to the center of the bone, bone marrow). The deeper the destructive process penetrates, the more severe its consequences can be.

people with secondary syphilis suffer from bone lesions

How common is syphilis of the skeletal system?

Depending on the stage to which “general” syphilis has reached, the risk of developing bone syphilis will vary.

At the end of the primary period, aches and pains in joints and bones develop in approximately 20% of patients. Such symptoms are noted in every fifth patient.

Damage to the skeletal system in the secondary period develops in 10-15% of patients with syphilis. Most often it is expressed in the form of inflammation of the joints, and less often - of the bones.

Pain and aches are a fairly common signal that primary syphilis has become secondary.

In the tertiary period, damage to the skeletal system develops more often - in 20-30% of cases. As a rule, at this stage, the bones suffer much more and the joints suffer less. With late syphilis, a person begins to experience irreversible bone and joint deformations, which significantly reduce the patient’s quality of life.

Symptoms of syphilis of bones and joints at different stages

As we have already mentioned, at different stages of syphilis, bone lesions are expressed by different symptoms. The longer the disease remains untreated, the more severe bone syphilis manifests itself.

Let us consider the symptoms of the disease in the primary, secondary and tertiary periods, as well as the symptoms of congenital bone syphilis.

Primary period

In the primary period, bone syphilis manifests itself as arthralgia(joint pain) and bone pain.

As a rule, they begin at night and are accompanied by fever, weakness and malaise. Later, this condition is replaced by the appearance of a widespread rash. This change means that syphilis has entered the secondary stage.

After the rash appears, the temperature and pain in the joints and bones go away on their own.

Secondary period

At this stage, syphilis of the skeletal system usually manifests itself as damage to the joints - syphilitic polyarthritis. In the photo, the joints become swollen, the skin over them becomes swollen and tense. The symptoms of syphilitic arthritis are no different from normal arthritis - the joints hurt (especially at night), and the person has difficulty moving them.

Joint with syphilitic arthritis

Syphilitic polyarthritis mainly occurs:

• on my knees
• ankle and shoulder joints
• in the joints of the hands.

The damage to the joints is symmetrical - that is, it appears on both sides of the body.

The general condition of the patient may be accompanied by high fever, weakness and malaise.

Arthritis in secondary syphilis is completely reversible if treated correctly. They never go into ankylosis(when the articular surfaces grow together and the joint becomes completely motionless) and do not form contractures(when the limb cannot be bent or straightened to the end) - in contrast to tuberculosis of the joints.

Syphilitic arthritis in the secondary period of syphilis is completely reversible with proper treatment

Less commonly, secondary syphilis affects the bones. In this scenario, periostitis and osteoperiostitis develop. They are characterized by bone soreness, which intensifies at night, when palpated, when exposed to heat, and decreases during movement.

Tertiary period

If during this period the patient begins to develop syphilis of the skeletal system, it manifests itself as a gummous lesion (which we learned about above). A person may develop periostitis, osteoperiostitis and osteomyelitis.

For gummous bone lesions, the following are distinguished:

• diffuse damage (that is, spread over many bones)
• and focal (in individual bones).

Tertiary syphilis of the bone is manifested by its coarsening and pain if it is palpated or tapped. A characteristic sign of syphilitic bone damage is increased pain at night and its subsidence during the day, after physical activity(unlike tuberculosis, which is very similar in appearance to syphilis).

Overgrowth of the periosteum in bone syphilis

Bone hardening can manifest itself in two ways:

1. overgrowth of periosteum
2. gumma formation

Less commonly, tertiary syphilis affects the joints. They develop primary synovial and primary bone arthritis.

• Primary synovial arthritis is acute (reactive arthritis) and chronic (Cleton's arthritis). They are manifested by enlargement of the joints, pain and slight difficulty in movement in the joint. Acute arthritis occurs as a reaction to a nearby gumma (for example, in the bone), chronic arthritis - as an allergy to a hidden infection in the joint. Primary bone arthritis occurs if gumma forms on the articular surface of the bone. In this case, the formation is located in the intra-articular cavity and leads to joint deformation.

Secondary bone lesions

Often the formation of gumma, which began in one area, spreads to the neighboring one. Thus, gumma located on the nasal mucosa can spread to its bone and cartilage tissue and destroy part of it.

It is by this mechanism that world-famous syphilitic pathologies develop: a saddle-shaped (sunken) nose and perforation (formation of a hole) of the hard palate. More information about this can be found in the article “Tertiary syphilis”.

Joint in a newborn

Bone damage due to congenital syphilis

Separately, it is worth talking about the symptoms of congenital bone syphilis - this is the name of the disease that is transmitted to the child already in the womb of a sick mother.

With congenital syphilis, specific osteochondrosis develops in the first three months. This is a lesion of the growth zone of cartilage. In this case, its development is disrupted and calcification occurs (calcium salts are deposited). As a result, this place becomes very fragile and is often subject to intraosseous fractures. You can learn more about congenital syphilis in special material.

With such osteochondrosis, a special disease often develops - Parrot's pseudoparalysis. For example, the arm of a sick child hangs freely, and passive movements cause pain. At the same time, movements in the fingers remain possible. Parrot's pseudoparalysis rarely affects the lower extremities.

Specific osteochondrosis may be the most early symptom congenital syphilis

Between the ages of four and sixteen years, a child with congenital syphilis may begin to:

• specific periostitis;
• osteoperiostitis;
• osteomyelitis;
• saber-shaped shins are formed;
• sometimes gonitis occurs (inflammation of the knee joints);
• and hydroarthrosis (fluid accumulation in the joints).

How is syphilis of bones and joints diagnosed?

The main methods for diagnosing bone syphilis are x-rays and blood tests for syphilis.

X-rays must be taken in two projections (from two different points). There should be at least two tests for syphilis: one treponemal and one non-treponemal. You can read more about these tests in the article “Diagnostics of syphilis.”

If the examination results are questionable, then additional diagnostic methods are used:

• analysis of cerebrospinal fluid (CSF) for syphilis;
• computed tomography;
• magnetic resonance imaging;
• and joint arthroscopy.

As a rule, an experienced doctor can identify syphilis of the skeletal system in a patient without much difficulty.

Treatment of syphilis of bones and joints

Bone syphilis is treated with standard antibiotics against Treponema pallidum. Therapy consists of a course of antibiotic injections - usually penicillin. The duration and course of therapy depend on the stage of the general disease.

In addition to treatment with antibiotics, in the tertiary period of syphilis, surgical treatment of bones and joints may be necessary. However, it is also carried out only after treatment with antibiotics. Surgeries help get rid of bone defects that have formed during the illness, restore the shape of the bones and the functions of the joints.

Syphilis of bones and joints is a manifestation of a general syphilitic lesion of the body. The disease can begin at any stage of syphilis - even with congenital syphilis in children.

Bone damage in syphilis is completely reversible in its primary and secondary stages, but irreversible in the tertiary stages. If you start treatment only last stage, a person may be left with serious deformities and defects of joints and bones, preventing them from living normally. Without treatment, bone syphilis is painful and leads to disability and even complete paralysis.

X-rays and blood tests can help detect bone syphilis. Mild and moderate forms of bone syphilis are treated with penicillin antibiotics. Advanced bone syphilis can also be treated with antibiotics, but surgery may also be necessary after antibiotics.

It is important to remember that the sooner treatment for syphilis begins, the greater the chance for the patient to return to normal life - without serious consequences and complications.

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Osteoarticular tuberculosis. Elderly people get sick more often. Mainly affects the lumbar and thoracic vertebrae. Tuberculosis of the hip and knee joints is often encountered.

The development of the disease is influenced by body injuries, the degree of virulence of the microflora, and the degree of body resistance.

Bone tuberculosis is characterized by the development of specific osteomyelitis. First of all, the process affects the metaphyses and epiphyses of the tubular bones, in which caseous decay develops.

Small cavities are formed in the bone, which contain centrally located soft round sequestra. In the surrounding tissues there is reactive inflammation.

With tuberculous osteomyelitis of the vertebrae, a cold abscess develops in the area of ​​necrosis (mainly the anterior part of the vertebra) - as a result, deformation develops, and the vertebra becomes wedge-shaped. Severe complications include compression of the spinal cord.

Articular tuberculosis.

Synovial form - characterized by increased secretion of exudate from the synovial membranes of the joint. The exudate may be reabsorbed, or fibrin deposits – “grains of rice” – may occur, which limits the movement of the limb.

Fungal form – processes of productive inflammation predominate. The joint cavity is filled with granulation tissue, which grows into the joint capsule and surrounding soft tissue. The joint increases in size, the skin over it becomes pale and thinned, and a “white tumor” appears.

Bone form - characterized by a picture of primary osteitis against the background of reactive inflammation of the joint. The inflammation is infiltrative in nature. It causes increasing contracture of the joint, accompanied by the appearance of fistulas and the occurrence of pathological dislocations, and the addition of a secondary infection.

Clinic of osteoarticular tuberculosis.

General anesthesia. Modern ideas about the mechanisms of general anesthesia. Classification of anesthesia. Preparing patients for anesthesia, premedication and its implementation.

Inhalation anesthesia. Equipment and types of inhalation anesthesia. Modern inhalational anesthetics, muscle relaxants. Stages of anesthesia.

Intravenous anesthesia. Basic drugs. Neuroleptanalgesia.

Modern combined intubation anesthesia. The sequence of its implementation and its advantages. Complications of anesthesia and the immediate post-anesthesia period, their prevention and treatment.

Methodology for examining a surgical patient. General clinical examination (examination, thermometry, palpation, percussion, auscultation), laboratory research methods.

Preoperative period. Concepts about indications and contraindications for surgery. Preparation for emergency, urgent and planned operations.

Surgical operations. Types of operations. Stages of surgical operations. Legal basis for the operation.

Postoperative period. The patient's body's response to surgical trauma.

General reaction of the body to surgical trauma.

Postoperative complications. Prevention and treatment of postoperative complications.

Bleeding and blood loss. Mechanisms of bleeding. Local and general symptoms of bleeding. Diagnostics. Assessing the severity of blood loss. The body's response to blood loss.

Temporary and definitive methods of stopping bleeding.

History of the doctrine of blood transfusion. Immunological basis of blood transfusion.

Group systems of erythrocytes. The AB0 group system and the Rh group system. Methods for determining blood groups using the AB0 and Rh systems.

The meaning and methods of determining individual compatibility (av0) and Rh compatibility. Biological compatibility. Responsibilities of a blood transfusion physician.

Classification of adverse effects of blood transfusions

Water and electrolyte disturbances in surgical patients and principles of infusion therapy. Indications, dangers and complications. Solutions for infusion therapy. Treatment of complications of infusion therapy.

Injuries, traumatism. Classification. General principles of diagnosis. Stages of assistance.

Closed soft tissue injuries. Bruises, sprains, tears. Clinic, diagnosis, treatment.

Traumatic toxicosis. Pathogenesis, clinical picture. Modern methods of treatment.

Critical impairment of life in surgical patients. Fainting. Collapse. Shock.

Terminal states: preagonia, agony, clinical death. Signs of biological death. Resuscitation measures. Performance criteria.

Damage to the skull. Concussion, bruise, compression. First aid, transportation. Principles of treatment.

Chest injury. Classification. Pneumothorax, its types. Principles of first aid. Hemothorax. Clinic. Diagnostics. First aid. Transportation of victims with chest trauma.

Abdominal injury. Damage to the abdominal organs and retroperitoneal space. Clinical picture. Modern methods of diagnosis and treatment. Features of combined trauma.

Dislocations. Clinical picture, classification, diagnosis. First aid, treatment of sprains.

Fractures. Classification, clinical picture. Diagnosis of fractures. First aid for fractures.

Conservative treatment of fractures.

Wounds. Classification of wounds. Clinical picture. General and local reaction of the body. Diagnosis of wounds.

Classification of wounds

Types of wound healing. The course of the wound process. Morphological and biochemical changes in the wound. Principles of treatment of “fresh” wounds. Types of sutures (primary, primary - delayed, secondary).

Infectious complications of wounds. Purulent wounds. Clinical picture of purulent wounds. Microflora. General and local reaction of the body. Principles of general and local treatment of purulent wounds.

Endoscopy. History of development. Areas of use. Videoendoscopic methods of diagnosis and treatment. Indications, contraindications, possible complications.

Thermal, chemical and radiation burns. Pathogenesis. Classification and clinical picture. Forecast. Burn disease. First aid for burns. Principles of local and general treatment.

Electrical injury. Pathogenesis, clinical picture, general and local treatment.

Frostbite. Etiology. Pathogenesis. Clinical picture. Principles of general and local treatment.

Acute purulent diseases of the skin and subcutaneous tissue: boil, furunculosis, carbuncle, lymphangitis, lymphadenitis, hidradenitis.

Acute purulent diseases of the skin and subcutaneous tissue: erysopeloid, erysipelas, phlegmon, abscesses. Etiology, pathogenesis, clinical picture, general and local treatment.

Acute purulent diseases of cellular spaces. Cellulitis of the neck. Axillary and subpectoral phlegmon. Subfascial and intermuscular phlegmon of the extremities.

Purulent mediastinitis. Purulent paranephritis. Acute paraproctitis, rectal fistulas.

Acute purulent diseases of the glandular organs. Mastitis, purulent parotitis.

Purulent diseases of the hand. Panaritiums. Phlegmon of the hand.

Purulent diseases of serous cavities (pleurisy, peritonitis). Etiology, pathogenesis, clinical picture, treatment.

Surgical sepsis. Classification. Etiology and pathogenesis. An idea of ​​the entrance gate, the role of macro- and microorganisms in the development of sepsis. Clinical picture, diagnosis, treatment.

Acute purulent diseases of bones and joints. Acute hematogenous osteomyelitis. Acute purulent arthritis. Etiology, pathogenesis. Clinical picture. Therapeutic tactics.

Chronic hematogenous osteomyelitis. Traumatic osteomyelitis. Etiology, pathogenesis. Clinical picture. Therapeutic tactics.

Chronic surgical infection. Tuberculosis of bones and joints. Tuberculous spondylitis, coxitis, drives. Principles of general and local treatment. Syphilis of bones and joints. Actinomycosis.

Anaerobic infection. Gas phlegmon, gas gangrene. Etiology, clinical picture, diagnosis, treatment. Prevention.

Tetanus. Etiology, pathogenesis, treatment. Prevention.

Tumors. Definition. Epidemiology. Etiology of tumors. Classification.

1. Differences between benign and malignant tumors

Local differences between malignant and benign tumors

Fundamentals of surgery for regional circulatory disorders. Arterial blood flow disorders (acute and chronic). Clinic, diagnosis, treatment.

Necrosis. Dry and wet gangrene. Ulcers, fistulas, bedsores. Causes of occurrence. Classification. Prevention. Methods of local and general treatment.

Malformations of the skull, musculoskeletal system, digestive and genitourinary systems. Congenital heart defects. Clinical picture, diagnosis, treatment.

Parasitic surgical diseases. Etiology, clinical picture, diagnosis, treatment.

General issues of plastic surgery. Skin, bone, vascular plastic surgery. Filatov stem. Free transplantation of tissues and organs. Tissue incompatibility and methods for overcoming it.

Chronic surgical infection. Tuberculosis of bones and joints. Tuberculous spondylitis, coxitis, drives. Principles of general and local treatment. Syphilis of bones and joints. Actinomycosis.

Osteoarticular tuberculosis. Elderly people get sick more often. Mainly affects the lumbar and thoracic vertebrae. Tuberculosis of the hip and knee joints is often encountered.

The development of the disease is influenced by body injuries, the degree of virulence of the microflora, and the degree of body resistance.

Bone tuberculosis is characterized by the development of specific osteomyelitis. First of all, the process affects the metaphyses and epiphyses of the tubular bones, in which caseous decay develops.

Small cavities are formed in the bone, which contain centrally located soft round sequestra. In the surrounding tissues there is reactive inflammation.

With tuberculous osteomyelitis of the vertebrae, a cold abscess develops in the area of ​​necrosis (mainly the anterior part of the vertebra) - as a result, deformation develops, and the vertebra becomes wedge-shaped. Severe complications include compression of the spinal cord.

Articular tuberculosis.

Synovial form - characterized by increased secretion of exudate from the synovial membranes of the joint. The exudate may be reabsorbed, or fibrin deposits – “grains of rice” – may occur, which limits the movement of the limb.

Fungal form – processes of productive inflammation predominate. The joint cavity is filled with granulation tissue, which grows into the joint capsule and surrounding soft tissue. The joint increases in size, the skin over it becomes pale and thinned, and a “white tumor” appears.

Bone form - characterized by a picture of primary osteitis against the background of reactive inflammation of the joint. The inflammation is infiltrative in nature. It causes increasing contracture of the joint, accompanied by the appearance of fistulas and the occurrence of pathological dislocations, and the addition of a secondary infection.

Clinic of osteoarticular tuberculosis.

Gradual start.

After a long time, local symptoms appear - pain, limited function, deformation of the affected limb or poor posture, muscle atrophy.

Pain occurs due to toxic irritation of nerve endings or compression by inflammatory infiltrate.

General treatment.

Increase the body's resistance - good nutrition, Fresh air, solar radiation (heliotherapy), climatotherapy, physical therapy, the use of blood products and chemotherapeutic agents.

Antibacterial therapy (ftivazide, rifadin, ethambutol).

Local treatment.

Conservative measures.

Unloading of bones and joints, immobilization (traction, plaster casts).

Physiotherapeutic procedures – laser therapy

Surgical methods.

Punctures of cold abscesses, articular resections, amputations, osteoarticular plastics, immobilizing and corrective orthopedic operations (economical resections, spinal fixation, intra-articular arthrodesis, etc.).

Bone resections.

Plastic surgery of bones and joints.

With complete destruction of bones and joints - amputation.

Tuberculous lymphadenitis.

Tuberculous lymphadenitis affects approximately one third of all patients with surgical tuberculosis.

There are tuberculosis of bronchial (airborne infection), mesenteric (infection through the digestive organs) and cervical lymph nodes.

The disease has a chronic course. The general condition of the patient is satisfactory. The temperature is subfebrile. Exacerbations of the process are often observed, the disease is seasonal - in the summer the lymph nodes decrease, in the winter they increase.

Differential diagnosis – with actinomycosis, lymphogranulomatosis, lymphosarcoma, etc.

Conservative therapy - heliotherapy, ultraviolet and x-ray radiation, laser therapy. Antibacterial therapy.

Surgical treatment - when blood vessels, nerves, and respiratory tracts are compressed by enlarged lymph nodes, the conglomerate of lymph nodes is extirpated.

Syphilis of bones and joints

Syphilis (syphilis, lues) is a chronic progressive infectious disease caused by Treponema pallidum, affecting all human organs and tissues. It is characterized by both a chronic course with periods of absence of clinical manifestations (hidden, latent syphilis) and pronounced clinical manifestations (active syphilis).

Syphilis is transmitted through minor damage to the skin or mucous membranes (acquired syphilis), most often through sexual intercourse. A possible route of transmission from mother to fetus is through the placenta (congenital syphilis).

Diagnosis is based on data from serological methods (Wassermann reaction, etc.).

The clinical picture in some cases develops relatively quickly, in others, on the contrary, many months or even years after infection. Often the patient himself does not know when and how he became infected.

Today, syphilis of bones and joints is quite rare, however, it is necessary to know its manifestations in order to carry out a differential diagnosis of other more common diseases.

Osteoarticular manifestations are observed in the 3rd period.

It develops soon after the appearance of secondary symptoms or several months or even years later. It is characterized by the formation of gumma - a specific infectious granuloma in the form of a tumor, reaching up to 10 cm in diameter. On a section, gumma has the appearance of a gelatinous gray-red granulating soft mass. Histologically, it consists of lymphocytes, plasma cells, sometimes giant cells and fibroblasts from which connective tissue grows. A characteristic symptom of gummas is inflammation of blood vessels - syphilitic vasculitis and perivasculitis. That. in the center of the gumma, due to a violation of trophism, necrosis occurs, and at the periphery, connective tissue grows, forming a dense capsule from which connective tissue strands go to the center. Gummas can be single or multiple. Superficially located gummas usually ulcerate, and a nonspecific infection may occur; if they are deep, they may become calcified, fibrotic, or form a cyst with crumbly purulent masses. Gummas are located randomly in the body, so the manifestations of tertiary syphilis are extremely diverse. Often this diversity leads to diagnostic errors and “unnecessary operations”. Cases have been described when gumma was mistaken for a neoplasm of the mammary gland, esophagus, liver, brain, etc., as well as for tuberculosis. With gummous bone lesions, in addition to periostitis, as in secondary syphilis, damage to the bone marrow and bone tissue itself occurs (osteomyelitis and osteitis). The diaphyses of bones (forearms and legs) are usually affected, which distinguishes syphilis from tuberculosis, which develops mainly in the epiphyses, and from nonspecific purulent osteomyelitis, more often observed in the metaphyses. Due to the diaphyseal location, the process often spreads to the joints, affecting all its structures, resulting in syphilitic osteoarthritis.

Diagnosing syphilis with typical symptoms is not difficult. If the clinical picture is unclear, they resort to serological and x-ray examination. It is possible to use CT, MRI, ultrasound. In rare cases, a biopsy is performed.

Treatment of syphilis can be divided into specific and nonspecific.

Specific treatment of syphilis should be started as early as possible and carried out in specialized institutions. However, if the patient is forced to stay in a surgical hospital, it is necessary to isolate him and begin specific therapy.

Nonspecific treatment is the surgical treatment of syphilitic changes in various organs. For example, bone grafting for bone damage, surgery for stenosis of a hollow organ with syphilitic gum.

The disease progresses favorably only in case of early recognition and timely treatment in specialized institutions.

Actinomycosis

Actinomycosis (actis-ray, myces-fungus) is a chronic specific infectious disease caused by radiant fungi of the genus Actinomycetes, characterized by the formation of dense infiltrates that have progressive growth and consist of specific drusen.

The drusen consists of an outer layer, which is a flask-shaped formation located in the form of a beam, and an inner layer, consisting of threads that from the outer layer are directed to the center, where they form dense plexuses. The radial arrangement of the outer thickenings of the threads explains the name “radiant fungus”.

Actinomycetes are widespread in nature. Usually the fungus grows on cereal plants: on ears of rye, wheat, barley; it is also found on dry plant dust and in dry plants, hay, straw, where it remains viable for more than a year.

Given the habitat of the fungus, actinomycosis most often affects rural residents.

Infection occurs when actinomycetes penetrate through damage to the skin and mucous membranes.

The tissue reaction to the introduction of radiant fungus is expressed in slowly developing chronic inflammation. The inflammatory process has the character of a proliferative, gradually progressive development of dense connective tissue (granuloma). The granulations surround the colonies of the fungus in a dense ring, gradually sprouting healthy tissues encountered along the way, tightly fusing with them. A woody density infiltrate is formed, tightly fused with the surrounding tissues, reminiscent of the growth of a malignant tumor. This must be taken into account in the differential diagnosis of the disease.

There are cutaneous, cervicofacial, intestinal and pulmonary forms of actinomycosis.

From a surgical point of view, primary actinomycosis of the skin is of interest when it develops as a result of the penetration of actinomycetes from the outside during injuries or wounds.

Clinical picture. There are nodular, tubercular, tubercular-pustular, ulcerative and atheromatous clinical forms of skin actinomycosis.

With nodular form a dense or densely elastic, sedentary, painless infiltrate in the deep layers of the skin measuring 3 x 4 cm or more. As the infiltrate increases, it protrudes above the level of the surrounding skin, which acquires a dark red color with a purple tint.

New ones often develop near the main outbreak. In gummous form the nodes abscess and open with the formation of several fistulas. In purulent discharge, yellowish grains can often be found - actinomycete drusen. Some fistulas are scarred, but new ones soon appear.

Tuberous form usually develops with primary actinomycosis of the skin in the form of small (0.5x0.5 cm), non-merging, dense, painless, hemispherical, dark red tubercles. Most of them abscess, opening with the release of a drop of pus. Later, fistulas form, periodically becoming covered with brown-yellow crusts. The process tends to affect the subcutaneous fatty tissue and spread to neighboring areas.

Ulcerative form usually occurs in weakened patients at the site of abscessed infiltrates. The edges of the ulcers are soft, undermined, uneven, the skin around them is bluish in color. The bottom of the ulcers is covered with necrotic tissues and flaccid granulations. Ulcers most often occur in places where there is loose subcutaneous tissue (supra- and infraclavicular areas, axillae).

Atheromatous form occurs more often in children. The infiltrate is round in shape, up to 5 cm in diameter, elastic in consistency, with clear boundaries, reminiscent of true atheroma; subsequently the infiltrate abscesses with the release of pus and the formation of a fistula.

Diagnosis of actinomycosis requires confirmation by microbiological examination of discharge from fistulas, a skin allergic reaction with actinolysate and histological examination of infiltrated tissue.

Treatment of patients with actinomycosis is carried out in specialized hospitals. Surgical treatment consists of excision of the affected tissue and is carried out in combination with immunotherapy. General strengthening and immunostimulating treatment is also carried out.

With local forms of the disease and adequate comprehensive treatment, the prognosis is favorable.

Surgeons are interested in a special type of actinomycosis - Madura foot - a chronic disease of non-contagious fungal etiology, which is characterized by damage to soft tissues, bones of the lower limb and other parts of the human body.

Hyperkeratosis, hyperpigmentation, peeling and hemorrhages are noted on the limb.

In most cases, “elephant foot” develops due to lymphostasis.

Treatment conservative and surgical. In advanced cases, the limb is amputated.

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