From Big Medical Encyclopedia

PANARTHRITIS (panarthritis; grech, pan all + arthritis[es], synonym phlegmon of a joint) — the acute purulent arthritis proceeding with defeat of all anatomic formations of a joint (bones, cartilages, a synovial membrane, sheaves) and with a purulent inflammation of the soft tissues surrounding it.

On etiologies The item does not differ from acute purulent arthritis, he is called pyogenic, hl. obr. staphylococcal and streptococcal microflora, is much more rare causative agents of a mephitic and putrefactive gangrene. Most often infection of a joint happens directly through defect of covers — a wound, fistula, is much more rare by implementation of per continuitatem activators or a hematogenous way.

The item, as a rule, arises in the presence in a joint of considerable mass of the fabrics which died owing to an injury or preceding patol. process that creates optimal conditions for development of an infection. The item can develop, e.g., at the started, led to formation of fistulas, tubercular damage of a joint with big destruction of bone and cartilaginous tissue. However by 30th 20 century similar cases became a rarity. Most often P. is a complication of the getting gunshot wounds of the joints which are followed by considerable destruction of an epiphysis of the bones and which timely did not undergo radical surgical treatment. At small (to 0,4%) parts of such wounded during the Great Patriotic War especially terrible acute putrefactive Item was observed. At less severe open injury of a joint transition of the arisen purulent arthritis to P. is possible in connection with overdue or irrational treatment. especially at the broken adaptive (protective) reactivity of an organism.

Pathoanatomical The item is characterized by a combination of signs of purulent osteoarthritis (see) and periartikulyarny phlegmons (see).

Always find nekrotizirovanny fragments of a bone or bone sequesters (see. Sequester, sequestration ). At a prolonged current big masses is formed granulyatsionny fabric (see); sluggish vitreous granulations can act from wound openings or fistulas in the form of fungoid growths. In especially hard cases of fire P. perhaps bystry distribution is purulent - necrotic process from the struck epiphysis in a marrowy cavity on all diaphysis of a bone.

Wedge, picture The item differs from a picture of acute purulent arthritis in symptoms of suppuration in soft tissues (a dermahemia, infiltration with sites of a softening, fluctuation), and also weight of the general frustration. The last (it is purulent - resorptive fever, very high leukocytes with a deviation to the left, etc.) are expressed to those more sharply, than the affected joint is larger. However the current of P. which developed against the background of traumatic exhaustion of the patient or is long existing and torpidno progressing, can be fever-free, with poorly expressed leukocytic reaction, but with an aneosinophilia, with the accruing erythropenias and hypochromia anemia. Such current is especially adverse. For it is long the existing P. education is characteristic purulent zatek (see), sometimes at very long distance from a joint.

For diagnoses The item, in addition to described a wedge, symptoms, it is very important rentgenol. the research revealing weight and prevalence inf. process.

Treatment Item only operational, whenever possible early and radical. Arthrotomies are useless, the extensive resection of the affected joint with obligatory opening and drainage of zatek if they are available, with a reliable immobilization and performing the most vigorous antibacterial and fortifying therapy, an immunotherapy and topical administration of proteolytic enzymes is shown. In especially hard cases and at unsuccessfulness of a resection amputation of an extremity (is inevitable at P. of coxofemoral or humeral joints — an exarticulation).

Forecast at P. always the most serious. The ancient mnemonic formula characterizes P.'s outcome as one of three losses: at the most successful treatment of P. leads to an immovability of a joint (loss of function); for rescue of the patient amputation (loss of an extremity) can be required; at unsuccessfulness of treatment of the patient perishes from sepsis (loss of life).

Prevention — timely correct operational and conservative treatment of wounds of joints and them inf. defeats (see. Arthritises, acute purulent arthritis , Joints ).

Bibliography: Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 17, page 51, M., 1953; With t r at the h to about in V. I. Purulent surgery, M., 1967.

S. A. Rusanov.