2/14/17 Spivak Bone and Joint TEST #2 Flashcards
What is the hematogenous source of Osteomyelitis?
- Staph aureus (gram + organisms)
- Gram - rods
What are three broad sources of getting osteomyelitis?
- Hematogenous (monomicrobial)
- Contiguous spread (periodontal)
- Direct inoculation (result of trauma or surgery)
What location of the body do we see hematogenous osteomylitis in children?
-long bones
What location of the body do we see hematogenous osteomyelitis in adults?
-Vertebrae
What is sequestra?
-Separated dead bone
In the anatomic classification of osteomyelitis what is Stage 1?
-Medullary
In the anatomic classification of osteomyelitis what is stage 2?
-Superficial (involves only the cortical bone)
In the anatomic classification of osteomyelitis what is stage 3?
-Localized (involves both cortical and medullary bone, but doesn’t involve the entire diameter of the bone)
In the anatomic classification of osteomyelitis what is stage 4?
-Diffuse (involve the entire thickness of the bone)
If you have infection prior to development of sequestra do you have acute or chronic osteomyelitis?
-Acute
If you have an acute classification of osteomyelitis what is the time frame you have to be in?
-Less than 2 weeks
If you have an infection after sequestra have formed to you have acute or chronic osteomyelitis?
-Chronic
What are three hallmarks that you find in chronic osteomyelitis?
- Formation of involucrum (new bone development)
- Bone loss
- Sinus tract formation
If you have chronic osteomyelitis can you treat it with antibiotics alone?
-No it will also require surgery
What are the acute clinical presentations of osteomyelitis?
- Gradual onset over several days
- Dull pain/local tenderness on exam
- Warmth, erythema, swelling, fevers may happen
- Septic arthritis (possibly)
What are the chronic clinical presentations of osteomyelitis?
- Mild pain over several weeks
- Localized swelling or erythema
- Draining sinus tract
If you are looking for acute osteomyelitis can you see it typically on a plain x-ray?
- No usually takes an MRI
- Chronic you can see on a radiograph
How do you treat acute osteomyelitis?
-3-6 weeks antibiotics
What is the gold standard of osteomyelitis diagnosis?
-Bone biopsy
How do you treat chronic osteomyelitis?
-3-6 weeks antibiotics with surgery
What usually causes osteomyelitis of the jaw?
-Contiguous (spread from somewhere else)
Is the mandible or maxilla more susceptible to osteomyelitis of the jaw?
-Mandible
T/F The lingual aspect of the mandible in region of molar teeth is the greatest risk for osteomyelitis
True
What are the symptoms of osteomyelitis of the jaw?
- Mandibular pain
- Anesthesia/paresthesia on affected side
- Lymphadenopathy
- Progress to trismus
What is the treatment for osteomyelitis of the jaw?
-Combo of surgery and antibiotics targeting oral flora
What are two types of medicines that are associated with osteonecrosis of the jaw?
- Antiresorptive
- Antiangiogenic
What are the leading cause of arthroplasty failure?
-Prosthetic Joint Infections
What type of bacteria cause Prosthetic joint infections?
- gram + cocci (65%)
- Aerobic gram - bacilli 6%
- anaerobes 4%
- Polymicrobial 20%
What are five surgical management options to treat Prosthetic joint infections?
- Debridement and retention
- 2 stage exchange
- 1 stage exchange
- Resection arthroplasty with arthrodesis (fusion)
- Amputation
When you do a debridement and retention surgery for PJIs what type of therapy do you do for treatment?
-2-6 weeks of IV therapy + rifampin
T/F In general, for patients with prosthetic joint implants, prophylactic antibiotics are recommended prior to dental procedures to prevent prosthetic joint infections.
False
-Antibiotics are not recommended
