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Bone And Joint Infection Flashcards

1
Q

Is acute or chronic septic arthritis pyogenic

A

Acute - hot swollen

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2
Q

Is septic arthritis more commonly mono articular or poly articular

A

Mono

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3
Q

Most common route for pathogens to reach joint in septic arthritis

A

Blood

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4
Q

Routes for pathogens to enter joint

A

Local soft tissue infection
Diagnostic or therapeutic procedures
Penetrating trauma
Adjacent osteomyelitis
Haematogenous

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5
Q

Most common organisms causing septic arthritis

A

Staphylococcus aureus

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6
Q

Septic arthritis risk factors

A

Previous damage to joint
Untreated systemic infection
Condition effecting blood supply to the joint

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7
Q

Joint most commonly effected by septic arthritis

A

Knee

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8
Q

what does elevated ESR and CRP show

A

Ongoing inflammatory reaction

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9
Q

How does synovial fluid appear on examination in septic arthritis

A

Turbid
Purulent
High leukocytes predominantly neutrophils
Glucose <25mg/dL - less than serum

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10
Q

Main leukocyte in septic arthritis

A

Neutrophil

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11
Q

Septic arthritis signs on radiology

A

Soft tissue swellings
Joint capsule distension
Erosion of articular surface

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12
Q

What type of septic arthritis causes joint space narrowing, effusion, erosions, and cyst formation on XR

A

Mycobacteria infection

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13
Q

Septic arthritis treatment

A

Drainage and washout every few days
Antibiotics

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14
Q

Reactive arthritis

A

inflammatory arthritis that manifests several days to weeks after a gastrointestinal or genitourinary infection

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15
Q

Presence of Which HLA increases reactive arthritis risk

A

HLA-B27

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16
Q

Reactive arthritis symtoms

A

Eye inflammation
Lower back pain
Diarrhoea
Scaly skin patches on genitals
Swelling in knee heel of ball of foot
Flaky skin on foot sole
Sausage toes

17
Q

How does TB infection reach the sacroiliac joint

A

Travels down psoas major

18
Q

How does osteomyelitis spread

A

Haematogenous
From adjacent infected focus

19
Q

Osteomyelitis risk factors

A

Impaired immune system
Impaired local vascular supply - diabetes mellitus, venous stasis, radiation fibrosis, SCD

20
Q

Why is diabetes mellitus a risk factor for bacterial infections

A

Uncontrolled blood sugar feeds bacteria

21
Q

Radiation fibrosis

A

Scar tissue that develops as a result of damage from radiotherapy

22
Q

Osteomyelitis signs and symptoms

A

Decreased limb movement
Adjacent joint effusion
Local non specific pain
Elevated neutrophil count
Elevated ESR

23
Q

Which type of osteomyelitis has rapid onset and which has insidious onset over 1-3 months

A

Rapid - Haematogenous long bone
Insidious - Haematogenous vertebral and chronic

24
Q

Brodies abscess

A

Subacute osteomyelitis
Lesion with central lyric region and sclerotic margins

25
Q

Effects of chronic osteomyelitis

A

Local bone loss
Persistent drainage through sinus
Rare complications - squamous cell carcinoma, amyloidosis

26
Q

Osteomyelitis investigations

A

MRI
Bone scintigraphy
Bone biopsy
Blood culture
Neutrophil count
Radiography

27
Q

What imaging modality is used when suspicious of multi focal osteomyelitis

A

Bone scintigraphy

28
Q

How long is the lag between osteomyelitis infective course and changes being visible on XR

29
Q

Osteomyelitis management

A

Puncture and drainage of abscess
Surgical debridement of sequestrum - dead bone
Reconstruct bone - Allo/autograft
4-6wks antibiotics

30
Q

Sequestrum

A

piece of devascularised necrotic bone that becomes separated from the remainder of the bone in chronic osteomyelitis and acts as a nidus for ongoing infection

31
Q

Involucrum

A

Layer of new bone growth outside existing bone
In osteomyelitis the reactive bone that forms around the necrotic sequestrum

32
Q

Where does prosthetic bone and joint infection occur

A

Ossetian tissues adjacent to prosthesis - bone cement interface, bone contiguous with prosthesis

33
Q

Causes of prosthetic bone and joint infections

A

Local inoculation in surgery
Post op spread from surgical wound infection
Haematogenous spread

34
Q

How are risks of prosthetic bone and joint infection decreased

A

Prophylactic antibiotics given before surgery to Treat any minor infections
Wound packed with cement beads impregnated with antibiotics

35
Q

Prosthetic bone and joint infection signs and symptoms

A

Gradual onset progressive joint pain
Sinus development
Incr ESR
incr neutrophil count
Prosthesis movement

36
Q

Prosthetic bone and joint infection on x ray

A

Lucencies at bone cement interface
Changes in component position
Cement fractures
Periosteal reactions
Gas in joint

37
Q

Prosthetic bone and joint infection management

A

Removal of prosthesis, antibiotics for 6 wks, re implantation of new prosthesis 4 wks after removal
Resection arthropathy
Suppressive long term antibiotics

LOCO2 (26 decks)

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