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Musculoskeletal > Bone and Joint Infection > Flashcards

Bone and Joint Infection Flashcards

1
Q

Calor

A

Heat

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2
Q

Dolor

A

Pain

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3
Q

Tumor

A

Swelling

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4
Q

Functio laesa

A

Loss of function

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5
Q

Sequestrum

A

When dead bone becomes detattched from healthy bone

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6
Q

Gold Standard test for osteomyelitis?

A

Bone culture

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7
Q

X-ray signs of osteomyelitis

A

Patchy osteopenia and signs of bone destruction

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8
Q

Why should you give special consideration to osteomyelitis of vertebral bodies?

A

It can lead to permanent neurological defects
Neurologic deficits are late findings secondary to vertebral body collapse or epidural abscess. MRI is the best imaging study for osteomyelitis

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9
Q

What is diskitis

A

diskitis is an infection in the intervertebral disc space that affects different age groups, but usually spontaneously affects children under 8 years of age

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10
Q

What is an involucrum?

A

An involucrum is a complication of osteomyelitis and represents a thick sheath of periosteal new bone surrounding a sequestrum

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11
Q

Useful blood tests in osteomyelitis?

A

CRP and plasma viscosity

blood cultures, white cell count and ESR are occasionally useful

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12
Q

Causes of osteomyelitis

A

In most instances, osteomyelitis results from haematogeneous spread, although direct extension from trauma and/or ulcers is also relatively common (especially in the feet of diabetic patients).

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13
Q

Location of osteomyelitis

A

neonates: metaphysis and/or epiphysis
children: metaphysis
adults: epiphyses and subchondral regions

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14
Q

Organisms usually causing osteomyselitis

A

Staph aureus

Haemophilus in children

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15
Q

Causes of acute osteomyelitis

A

Staph aureus

Haemophilus in children

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16
Q

Tests used if chronic osteomyelitis is suspected?

A

X-ray and MRI

17
Q

Involucrum

A

An involucrum is a complication of osteomyelitis and represents a thick sheath of periosteal new bone surrounding a sequestrum.
Often seen in chronic osteomyelitis

18
Q

How does septic arthritis arise?

A

From inoculation
From metaphyseal spread
Direct haematogenous

19
Q

Treatment for cellulitis

A

Best guess antibiotics to cover staph and strep

Lecturer used flucloxacillin and benzylpenicillin

20
Q

Tests used if you suspect an infected arthroplasty

A

CRP
Joint aspiration
Bone scan (Technetium 99)
X ray

21
Q

Prophylaxis for osteomyelitis surgery/ bone surgery to prevent osteomyelitis

A

Easily measureable:

  • Clean air theatres
  • Local antibiotics
  • Systemic antibiotics
  • Duration of surgery

Not easily measurable:

  • Neat surgery
  • Quality of hand washing
  • Theatre discipline
22
Q

Clinical features of infection

A 
Pain
Swelling
Heat
Tenderness
Resistance to active or passive movement
23
Q

Diagnosis of infection

A

Raised temperature
Raised white cell count
Raised CRP

24
Q

Complications of infection (cartilage and …)

A
  • Destruction of articular cartilage, leading to pain and stiffness
  • Bone or fibrous ankylosis
25
Q

Prophylaxis for orthopaedic surgery

A

Laminar flow
24 hours antibiotics starting with induction
Antibiotics in cement

Co-amoxiclav
Flucloxacillin + gentamicin
Clindamycin
Co-trimoxazole

26
Q

Antibiotics used as prophylaxis for orthopaedic surgery

A

Co-amoxiclav
Flucloxacillin + gentamicin
Clindamycin
Co-trimoxazole

27
Q

CFGCC antibiotic prophylaxis for orthopaedic surgery

A
  • Co-amoxiclav
  • Flucloxacillin & gentamycin
  • Clindamycin
  • Co-trimoxazole
28
Q

Which ‘bugs’ do you need to provide prohpylaxis for in orthopaedic surgery?

A 
Staphylococcus aureus
Staphylococcus epidermidis (coagulase negative staphylococcus)

SA causing TKR/THR infection
96% sensitive to current prophylaxis

CNS causing THR/TKR infection
72% resistant to Flucloxacillin
40% resistant to Gentamicin
32% resistant to entire prophylactic regime

Current strategy tailored towards least problematic bug

29
Q

Organisms that cause early post operative infection?

A

Staph aureus
Streptococcus
Enterococcus

30
Q

Organisms that cause delayed (low grade) infection

3-24 months

A

Coagulase negative staphylococci

P. acnes

31
Q

Organisms that cause late infection (>24 months)

A

Staph. aureus

E. coli

32
Q

SIRS

systemic inflammatory response syndrome

A

SIRS: two or more of:
Temperature >38ºC or 90 beats/min
Respiratory rate >20 breaths/min or PaCO2 12,000 cells/mm3 or <4,000 cells/mm3

33
Q

Chronic infection, SIRS and antibiotics?

A

SIRS is usually absent in chronic infections, if it is absent then there is no need for immediate antibiotics

34
Q

Bacteria usually responsible for acute and chronic infections

A

Acute primary infections
S. aureus
Streptococcus spp

Chronic infections
CoNS
Propionibacteria

35
Q

Why can CRP be confusing in bone and joint infection?

A

Not always elevated, especially in chronic infections
Influenced by underlying disease and acute stress (surgery)
Only useful in monitoring cases without major surgery

36
Q

Sign standards for surgery prophylaxis antibiotics

A

The first dose must be given within 30 minutes of the start of surgery
Prophylaxis should not continue >24h after surgery

37
Q

What do you do if there is MRSA pre-op when you screen for it?

A

Decolonise if positive

Musculoskeletal (44 decks)

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