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Infection > Bone and Joint Infection > Flashcards

Bone and Joint Infection Flashcards

1
Q

What is the term for a bone infection?

A

Osteomyelitis

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2
Q

What is the term for a joint infection?

A

Septic arthritis

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3
Q

Epidemiology of acute osteomyelitis

A
  • mostly children (different ages)
  • boys > girls
  • history of trauma (minor)
  • other disease i.e. diabetes, rheum arthritis, immunocompromised, long term steroid treatment, sickle cell
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4
Q

Describe the source of infection in acute osteomyelitis

A

Haematogenous spread in children and elderly

Local spread from contiguous site of infection = trauma (open fracture), bone surgery, joint replacement

Secondary to vascular insufficiency

Infants; infected umbilical cord

Children; boils, tonsilitis, skin abrasions

Adults; UTI, arterial line

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5
Q

What are the most common organisms involved in acute osteomyelitis?

A
  • infants < 1 year = S. Aureus, group B strep, E.Coli
  • older children = S.Aureus, S.Pyogenes, H.Influenzae
  • Adults = S.Aureus
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6
Q

What are less common organisms in acute osteomyelitis?

A

Diabetic foot and pressure sores = mixed infection including anaerobes

Sickle cell disease = salmonella spp

Mycobacterium marinum (fishermen, filleters)

Candida (debilitating illness, HIV/AIDS)

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7
Q

What is the pathology of acute osteomyelitis?

A

Starts at metaphysis

Vascular stasis; venous congestion and arterial thrombosis

Acute inflam - increased pressure

Suppuration

Release of pressure (medulla, sub-periosteal, into joint)

Necrosis of bone (sequestrum)

New bone formation (involucrum)

Resolution - or not (chronic)

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8
Q

Where does acute osteomyeltitis occur?

A

Long bones - metaphysis

  • dital femur
  • proximal tibia
  • proximal humerus

Joints with intra-articular metaphysis

  • hip
  • elbow
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9
Q

What are the clinical features of acute osteomyelitis in an infant?

A
  • may be minimal signs or may be v ill
  • failure to thrive
  • poss drowsy or irritable
  • metaphyseal tenderness + swelling
  • decrease ROM
  • positional change
  • commonest around knee
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10
Q

What are the clinical features of acute osteomyelitis in a child?

A
  • severe pain
  • reluctant to move, not weight bearing
  • may be tender fever (swinging pyrexia) + tachycardia
  • malaise
  • toxaemia
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11
Q

What are the clinical features of acute osteomyelitis in an adult?

A
  • primary OM seen commonly in thoracolumbar spine
  • backache
  • history of UTI or urological procedure
  • elderly, diabetic, immunocompromised
  • secondary OM much more common
  • often after open fracture, surgery
  • mixture of organisms
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12
Q

How is acute osteomyelitis diagnosed?

A
  • history and clinical examination (pulse and temp)
  • FBC + diff WBC (neutrophil leucocytosis)
  • ESR and CRP
  • blood cultures x3 (at peak temp 60% +ve)
  • U&Es; ill, dehydrates
  • xray, US, aspiration
  • isotope bone scan
  • labelled white cell scan
  • MRI
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13
Q

What are differentials for acute osteomyelitis?

A
  • acute septic arthritis
  • acute inflammatory arthritis
  • trauma (fracture, dislocation etc.)
  • transient synovitis
  • rarely sickle cell crisis, Gaucher’s disease, rheumatic fever, haemophilia
  • soft tissue infection
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14
Q

Describe radiographs in acute osteomyelitis?

A
  • early radiographs minimal change
  • 10-20 days early periosteal changes
  • medullary changes lytic areas
  • late osteonecrosis (sequestrum)
  • late periosteal new bone (involucrum)
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15
Q

What is the treatment for acute osteomyelitis?

A

Supportive treatment for pain and dehydration; general care and analgesia

Rest and splintage

Antibiotics;

  • route (IV/oral switch 7-10days)
  • duration (4-6wks depends on response, ESR)
  • choice - empirical (fluclox + BenzylPen) while waiting

Surgery

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16
Q

When should you consider surgery in acute osteomyelitis?

A
  • aspiration of pus for diagnosis and culture
  • abscess drainage
  • debridement of dead/infected/contaminated tissue
  • infected joint replacements?
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17
Q

What are complications of acute osteomyelitis?

A
  • septicaemia, death
  • metastatic infection
  • pathological fracture
  • septic arthritis
  • altered bone growth
  • chronic osteomyelitis
18
Q

Describe onset of chronic osteomyelitis

A

May follow acute

May start de novo

  • following operation
  • following open fracture (possibly many years earlier)
  • immunosuppressed, diabetics, elderly, drug abusers etc.

Repeated breakdown of healed wounds

19
Q

What organisms are involved in chronic osteomyelitis?

A

Often mixed

Usually same organisms each flare-up

Mostly S.Aureus, E.Coli, S.Pyogenes, proteus

20
Q

What is the pathology of chronic osteomyelitis?

A
  • cavities, poss sinus(es)
  • dead bone (retained sequestra)
  • involucrum
  • histological picture is one of chronic inflammation
21
Q

What are complications of chronic osteomyelitis?

A
  • chronically discharging sinus + flare-ups
  • ongoing (metastatic) infection (abscesses)
  • pathological fracture
  • growth disturbance + deformities
  • squamous cell carcinoma
22
Q

What is the treatment for chronic osteomyelitis?

A
  • long term Abs; local or systemic
  • eradicate bone infection; surgically (multiple ops)
  • treat soft tissue problems
  • deformity correction?
  • massive reconstruction?
  • amputation?
23
Q

Describe the route of infection in acute septic arthritis

A
  • haematogenous
  • eruption of bone abscess
  • direct invasion; penetrating wound, intra-articular injury, arthroscopy
24
Q

What are the common organisms in acute septic arthritis?

A
  • S.Aureus
  • H.Influenzae
  • S. Pyogenes
  • E.Coli
25
Q

Describe the pathology of acute septic arthritis

A

Acute synovitis with purulent joint effusion

Articular cartilage attacked by bacterial toxin and cellular enzyme

Complete destruction of articular cartilage

26
Q

What are the consequences of acute septic arthritis?

A

Complete recovery

or

Partial loss of articular cartilage and subsequent OA

or

Fibrous or bony ankylosis

27
Q

Describe the presentation of acute septic arthritis in a neonate

A

Picture of septicaemia

  • irritability
  • resistant to movement
  • ill
28
Q

Describe the presentation of acute septic arthritis in a child/adult

A

Acute pain in single large joint

  • reluctant to move joint
  • increase temp and pulse
  • increase tenderness
  • often superficial joint
  • rare in healthy adult
  • may be delayed diagnosis
29
Q

Describe diagnosis of acute septic athritis

A
  • FBC, WBC, ESR, CRP, bood cultures
  • xray
  • US
  • aspiration
30
Q

What is the most common cause of septic arthritis in adults?

A

Infected joint replacement

31
Q

What is the most common organism in acute septic arthritis?

A

Staph

32
Q

What are differential diagnoses for acute septic arthritis?

A
  • acute osteomyelitis
  • trauma
  • irritable joint
  • haemophilia
  • rheumatic fever
  • gout
  • gaucher’s disease
33
Q

What is the treatment for acute septic arthritis?

A
  • general supportive measures
  • antibiotics (3-4 weeks)
  • surgical drainage and lavage (emergency); open or arthroscopic lavage
34
Q

Describe clinical features of tuberculosis of one and joint

A
  • insidious onset, general ill health
  • contact with TB
  • pain, swelling, weight loss
  • low grade pyrexia
  • joint swelling
  • decrease ROM
  • ankylosis
  • deformity
35
Q

Describe the pathology of tuberculosis of bone and joint

A

Primary in lung or gut

Secondary spread

Tuberculous granuloma

36
Q

Describe spinal tuberculosis

A

Little pain

Present with abscess or kyphosis

37
Q

Describe diagnosis of tuberculosis of bone and joint

A
  • Long history
  • Involve single joint
  • Marked thickening of synovium
  • Marked muscle wasting
  • Periarticular osteoporosis
38
Q

Describe investigation of tuberculosis of bone and joint

A
  • FBC, ESR
  • mantoux test
  • sputum/urine culture
  • xray; soft tissue swelling, periarticular osteopaenia, articular space narrowing
  • joint aspiration and biopsy
39
Q

What are some differential diagnoses for tuberculosis of bone and joint?

A
  • transient synovitis
  • monoarticular RA
  • haemorrhagic arthritis
  • pyogenic arthritis
  • tumour
40
Q

Treatment of tuberculosis of bone and joint

A

Chemo;

  • initial 8 weeks rifampicin, isoniazid, ethambutol
  • THEN 6-12 month rifampicin and isoniazid

Rest and splintage
Operative drainage rarely necessary

Infection (15 decks)

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