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Year 2- MSK > Bone and Joint Infection Osteomyelitis/Septic Arthritis > Flashcards

Bone and Joint Infection Osteomyelitis/Septic Arthritis Flashcards

1
Q

What is the name of bone infection?

A

Osteomyelitis

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2
Q

What is the difference on x-ray between acute and chronic osteomyelitis?

A

Acute- no bone damage seen on x-ray
Chronic- bone damage seen on x-ray

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3
Q

Septic arthritis?

A

Infection of the joint

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4
Q

In which age group in acute osteomyelitis more common in?

A

Children
Boys > girls

->often in more deprived areas

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5
Q

Acute osteomyelitis can occur in adults, usually in those with underlying causes such as?

A

Usually some type of immunocompromise
e.g. diabetes, rheumatoid arthritis, steroids, sickle cell disease

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6
Q

What is usually the source of infection in acute osteomyelitis?

A

Usually haematogenous spread e.g. child scraping knee and entering through skin

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7
Q

Okay lets break this down a bit

In infants, what is the most common cause of infection which leads to acute osteomyelitis?

A

Infected umbilical cord

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8
Q

Okay lets break this down a bit

In children, what is the most common cause of infection which leads to acute osteomyelitis?

A

Boils, tonsillitis, skin abrasions

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9
Q

Okay lets break this down a bit

In adults, what is the most common cause of infection which leads to acute osteomyelitis?

A

UTI, arterial line, chest infection, gall bladder infection

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10
Q

What is the most common causative microorganism of acute osteomyelitis?

A

Staph. Aureus

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11
Q

What is the most common causative microorganism of acute osteomyelitis in infants <1yr?

A

Staph Aureus-most common
Group B streptococci- common in childbirth etc
E.Coli

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12
Q

What is the most common causative microorganism of acute osteomyelitis in older children?

A

Staph Aureus- most common
Strep pyogenes
Haemophilus influenzae

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13
Q

What is the most common causative microorganism of acute osteomyelitis in adults?

A

Staph Aureus- most common
Pseudomonas aeruginosa- often of foot

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14
Q

What would be the causative microorganism of patients with acute osteomyelitis and diabetic foot and pressure sores?

A

Mixed infection including anaerobes

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15
Q

Which microorganisms tend to cause vertebral osteomyelitis?

A

S.Aureus
TB

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16
Q

Which microorganisms tend to cause osteomyelitis related to sickle cell disease?

A

Salmonella

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17
Q

Which bones does acute osteomyelitis tend to affect more?

A

Long bones in the metaphysis- distal femur, proximal tibia/humerus

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18
Q

Which joints does acute osteomyelitis tend to affect more?

A

Joints with intra-articular metaphysis e.g. hip and elbow

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19
Q

How can a patient get septicaemia from osteomyelitis?

A

Build up of pus within bone- usually after trauma- which can burst out into the joint and cause infection of blood or septic arthritis

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20
Q

What is the treatment prognosis like for acute osteomyelitis?

A

As acute, can treat aggressively before bone destruction

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21
Q

Sequestrum?

A

Necrosis of bone, no blood supply

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22
Q

Involucrum?

A

Formation of new bone around the dead bone

23
Q

No matter how much antibiotic is given, it cannot get into the sequestrum, why is this?

A

It’s dead bone with no blood supply
The extra involucrum around it isolates the dead bone even more

->these factors are seen in chronic osteomyelitis

24
Q

What are the clinical features of acute osteomyelitis in infants?

A

Redness and infection around umbilicus
Failure to thrive
Not feeding
Pseudo-paralysis

25
Q

What are the clinical features of acute osteomyelitis in children?

A

Severe pain
Reluctant to move
Swinging pyrexia
Malaise; vomiting, nausea

->classical presentation is injury a few days ago but then fine shortly after, sore the next day, fever the day after, and progresses like that

26
Q

What are the clinical features of acute osteomyelitis in adults?

A

Backache- unremitting and at rest
History of UTI or urological procedure

->primary osteomyelitis most commonly seen in thoracolumbar spine hence backache

27
Q

Who is secondary osteomyelitis more common in?

A

Adults
Often after an open fracture or surgery

28
Q

Diagnosis of acute osteomyelitis and investigations?

A

History and clinical examination
Bloods: FBC, WBC, ESR, CRP
Blood cultures- repeated
U&E indicative of illness and dehydration
Bone biopsy occasionally to get organism and confirm diagnosis but not the common way of doing this
Bone scans

->some of these flashcards are a bit wordy but really recommend rewatching this lecture, really good

29
Q

What are ESR and CRP markers of?

A

Markers of inflammation

30
Q

X-ray can be done for acute osteomyelitis but what needs to be bared in mind?

A

Normal in first 10-14 days after injury

31
Q

What is seen in x-ray in acute osteomyelitis after 10-20 days?

A

Early periosteal changes and medullary changes

32
Q

What can be shown by x-rays later into osteomyelitis, when it is potentially reaching the chronic phases?

A

Sequestrum- bone necrosis
Involucrum - new bone

33
Q

If giving a child an MRI, what may they need?

A

If less than six, a general anaesthetic so they stay still!!

34
Q

What is done for a microbiological diagnosis of acute osteomyelitis?

A

Blood cultures
Potential bone biopsy if not sure of primary source of culture

35
Q

Treatment of acute osteomyelitis?

A

Supportive- pain and hydration
Rest and splintage of limb
Antibiotics

->tends to be overtreated just to really reduce risks of chronic osteomyelitis which is a lifelong condition

36
Q

Acute osteomyelitis is very rarely treated using surgery but what are some of the surgical indications?

A

If required to collect aspiration of pus for diagnosis and culture

For abscess draining if fever not responding to treatment

Debridement of dead or infected tissue

37
Q

Complications of acute osteomyelitis?

A

Metastatic infection
Pathological fracture
Septic arthritis
Septicaemia, death
Altered bone growth
Chronic osteomyelitis

38
Q

Chronic osteomyelitis is a lot rarer, especially in children, but can follow acute osteomyelitis.
However, why else may it occur?

A

Following operation
Following open fracture
Immunosuppressed, diabetics, drug abusers

39
Q

Treatment of chronic osteomyelitis?

A

Long term antibiotics
Eradication of infected bone- often massive surgery
Amputation?

40
Q

Complications of chronic osteomyelitis?

A

Chronically discharging sinus and flare-ups
Ongoing metastatic infection
Pathological fracture

Marjolin’s ulcer- very rare but a type of squamous cell carcinoma due to chronic discharge of bone and irritation of local tissues

41
Q

What are some of the routes of infection of septic arthritis?

A

Haematogenous
Eruption of bone abscess
Direct invasion e.g. penetrating wounds

42
Q

Most common causative microorganisms of septic arthritis?

A

Staph.Aureus
Haemophilus influenzae
Streptococcus pyogenes
E.Coli

43
Q

Pathology behind septic arthritis?

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked by toxins leading to destruction of the cartilage

44
Q

Outcomes of acute septic arthritis?

A

Complete recovery
or
Partial loss of articular cartilage
or
Fibrous or bony ankylosis

45
Q

How does septic arthritis present in neonates?

A

Irritability
Resistant of joint movement
Septicaemia

46
Q

How does septic arthritis present in children?

A

Acute pain in single large joint
Tachycardia
Pyrexia
Tenderness

47
Q

What is the difference between a child with a skin infection and a child with acute septic arthritis?

A

Acute septic arthritis has such severe pain that child will not let you touch the joint

48
Q

Treatment of acute septic arthritis?

A

General supportive measures
Urgent surgical drainage
Antibiotics
Infected joint replacements

49
Q

TB can affect bones and joins and is known as being the ‘great mimic’.
Where can TB impact?

A

Extra-articular
Intra-articular
Vertebral bodies- multiple lesions in 1/3 of patients

50
Q

Clinical features of TB?

A

Insidious onset and general ill health
Contact with TB
Pain, esp at night
Sweating
Weight loss
Joint swelling
Low grade pyrexia
Progressive deformity

51
Q

Where is commonly the primary TB infection found in the body?

A

Lung or gut

->this then spreads e.g. vertebral joints

52
Q

Which investigations are used to diagnose TB?

A

Bloods; FBC, ESR
Sputum/urine culture
X-rays
Joint aspiration and biopsy

53
Q

Treatment of TB?

A

Mostly antibiotics, combination of them

54
Q
A

Year 2- MSK (36 decks)

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