ACUTE OSTEOMYELITIS

Question 1

DEFINE

Answer 1

INFECTION AND INFLAMMATION OF BONE CAUSED BY MICRO ORGANISMS

Question 2

ETIOLOGY

Answer 2

STAPH AUREUS
GROUP A BETA STREPTOCOCCUS
BROUP B STREPTOCCCUS
E COLI
PSEUDOMONAS- IV DRUG USERS
KLINGELLA - YOUNG CHILDREN
SALMONELLA TYPHI - SICKLE CELL DISEASE
H. INFLUENZA - 1 TO 4 YEARS

Question 3

PATHOGENESIS

Answer 3

BACTERIAL ADHESION AND PROLIFERATION
INFLAMMATORY RXN
NEUTROPHIL INFILTRATION
FORMATION OF PUS
PUS GOES TO SURFACE OF BONE THROUGH VOLKMANN CANAL
SUB PERIOSTEAL ABSCESS FORMATION
PERIOSTEUM STRIPS OFF
ISCHAEMIA TO PART OF BONE
BONE NECROSIS
SEQUESTRUM FORMATION
IF SEQUESTRUM SMALL - GETS CLEARED BY PHAGOCYTES
IF LARGE - CANT BE REABSORBED
INVOLUCRUM FORMATION AROUND SEQUESTRUM
IF INFECTION PERSISTS
PUS AND SEQUESTRAL SPICULE DISCHARGE THROUGH CLOACAE FROM INVOLUCRUM
PERIOSTEUM PERFORATED
PUS IN SOFT TISSUE PLANE
PUS RELEASED WITH SINUS FORMATION .

Question 4

OSTEMYELITIS IN INFANT PECULARITIES

Answer 4

INFECTION CAN SPREAD FROM METAPHYSIS TO EPIPHYSIS INVOLVING JOINT BCOZ OF BLOOD SUPPLY

Question 5

SYMPTOMS

Answer 5

SEVERE PAIN
FEVER
SWELLING
PSEUDOPARALYSIS
INFANTS- REFUSAL TO FEED , FAILURE TO THRIVE, DROWSINESS, IRRITABILITY

Question 6

SIGNS

Answer 6

TOXIC LOOK
FEVER
DEHYDRATION
LIMB HELD STILL
PSEUDOPARALYSIS
LOCAL REDNESS , SWELLING , FLUCTUATION AND WARMTH

Question 7

IMAGING

Answer 7

X RAY
USG - SUB PERIOSTEAL COLLECTION OF PUS
MRI
BONE SCAN

Question 8

X RAY

Answer 8

CHANGES SEEN ONLY AFTER 2 WEEKS
RAREFRACTION - PATCHY
SEQUESTRUM APPEARS DENSER

Question 9

LAB INVESTIGATIONS

Answer 9

INCREASE CRP
INCREASE ESR
ASPIRATION OF PUS - SUREST METHOD OF DIAGNOSIS
LEUCOCYTOSIS

Question 10

TREATMENT

Answer 10

SUPPORTIVE TT
SPLINTAGE
ANTIBIOTICS
SURGICAL DRAINAGE

Question 11

SUPPORTIVE TT

Answer 11

ANALGESICS
IV FLUIDS

Question 12

SPLINTAGE

Answer 12

BY SIMPLE TRACTION OR SLAB

Question 13

ANTIBIOTICS

Answer 13

LESS THAN 6 MONTHS - FLUCLOXACILLION + 3RD GEN CEPHALOSPORIN
6 MONTHS TO 6 YEARS - FLUCLOXACILLION + 3RD GEN CEPHALOSPORIN
OLDER CHILDREN AND ADULTS - FUSIDIC ACID + FLUCLOXACILLIN
ELDERLY - FLUCLOXACILLIN + 3RD GEN CEPHALOSPORIN

Question 14

COMPLICATION

Answer 14

LOXCAL -
SEPTIC ARTHRITIS
CONVERSION TO CHRONIC OSTEOMYELITIS
PATHOLOGICAL #
EPIPHYSEAL DAMAGE
SYSTEMIC - SEPTICAEMIA
METASTATIC ABSCESS

Question 14

SURGICAL DRAINAGE

Answer 14

ABSCESS - INCISION AND DRAINAGE