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Musculo-skeletal > Bone and Joint Infections > Flashcards

Bone and Joint Infections Flashcards

1
Q

Which groups of patients are most likely to get acute osteomyelitis?

A
  • Children
  • Boys>girls
  • History of trauma
  • Other disease: diabetes, RA, immune compromise, long term steroids and sickle cell
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2
Q

What are the common routes of infection in acute osteomyelitis?

A
  • Haematogenous spread (children and elderly)
  • Local spread from contiguous site of infection: trauma, bone surgery and joint replacement
  • Secondary to vascular insufficiency
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3
Q

What are the common sources of infection in acute osteomyelitis?

A
  • Infants: infected umbilical cord
  • Children: boils tonsillitis and skin abrasions
  • Adults: UTI and arterial lines
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4
Q

What are the common organisms that cause acute osteomyelitis?

A
  • Infants <1yr: Staph aureus, Group B strep and E. coli
  • Children: Staph aureus, Strep pyogenes and H. influenzae
  • Adults: Staph aureus
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5
Q

Which organisms can cause acute osteomyelitis in prostheses?

A
  • Coagulase negative staphylococci

- Propionibacterium spp

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6
Q

What are the organisms that can cause acute osteomyelitis in specific groups of people?

A
  • Mycobacterium tuberculosis
  • Pseudomonas aeroginosa: IVDAs and penetrating foot injuries
  • Mixed infection: diabetic foot and pressure sores
  • Salmonella: Sickle cell
  • Mycobacterium marinum: fishermen and filleters
  • Candida: debilitating illness, HIV/AIDs
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7
Q

Which locations are most common for acute osteomyelitis?

A
  • Long bones: distal femur, proximal tibia and proximal humerus
  • Joints with intra-articular metaphysis: hip and elbow (radial head)
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8
Q

Describe the steps in the process of osteomyelitis

A
  • Starts at metaphysis
  • Vascular stasis
  • Acute inflamm. (increased pressure)
  • Suppuration
  • Release of pressure
  • Necrosis of bone (sequestrum)
  • New bone formation
  • Resolution or chronic osteomyelitis
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9
Q

What are the clinical features of osteomyelitis in an infant?

A
  • May be minimal signs or may be very ill
  • Failure to thrive
  • Possibly drowsy/irritable
  • Metaphyseal tenderness + swelling
  • Decreased ROM
  • Positional change
  • Most common around the 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
  • Tender, fever, tachycardia
  • Fatigue, nausea, vomiting, fretful
  • Toxaemia
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11
Q

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

A
  • Primary seen most commonly in the thoracolumbar spine
  • Backache
  • History of UTI/Urological procedure
  • Elderly, diabetic, immunocompromised
  • Secondary: commoner, found after open fracture surgery
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12
Q

How can acute osteomyelitis be diagnosed?

A
  • History and Exam: pulse + temp
  • FBC + diff WBC (neutrophil leucocytosis)
  • ESR &CRP
  • Blood cultures x3
  • U&Es: ill and dehydrated
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13
Q

What is the differential diagnosis for acute osteomyelitis?

A
  • Acute septic arthritis
  • Acute inflammatory arthritis
  • Trauma
  • Transient synovitis
  • Soft tissue infections
  • Rare: sickle cell crisis, Gaucher’s disease, rheumatic fever and haemophilia
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14
Q

Which scans can be used to diagnose acute osteomyelitis?

A
  • X-ray
  • USS
  • Aspiration
  • Isotope bone scan
  • Labelled white cell scan
  • MRI
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15
Q

How can acute osteomyelitis be microbiologically diagnosed?

A
  • Blood cultures: haematogenous osteomyelitis and septic arthritis
  • Bone biopsy
  • Tissue or swabs from up to 5 sites around implant (prosthetics)
  • Sinus tract and superficial swab results may be misleading
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16
Q

What is the treatment for osteomyelitis ?

A
  • Supportive: general care and analgesia
  • Rest and splintage
  • Antibiotics (4-6 weeks): Fluclox + Benzylpen whilst waiting on lab results
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17
Q

What are the indications for surgery in osteomyelitis?

A
  • Aspiration of pus for diagnosis and culture
  • Abscess drainage
  • Debridement of dead/infected/contaminated tissue
  • Refractory to non-operative Rx
18
Q

What are the complications of acute osteomyelitis?

A
  • Septicaemia/death
  • Metastatic infection
  • Pathological fracture
  • Septic arthritis
  • Altered bone growth
  • Chronic osteomyelitis
19
Q

What are the causes of the chronic osteomyelitis?

A
  • Acute osteomyelitis
  • Operations
  • Open fractures
  • Immunosuppressed, diabetics, elderly, drug abusers etc.
  • Repeated breakdown of healed wounds
20
Q

Which organisms can cause chronic osteomyelitis?

A
  • Often mixed infection

- Mostly staph aureus, E. coli, strep pyogenes and proteus

21
Q

Describe the pathology of chronic osteomyelitis

A
  • Cavity and possible sinuses
  • Dead bone
  • Involcrum
  • Chronic inflamm.`
22
Q

What are the complications of chronic osteomyelitis?

A
  • Chronically discharging sinus + flare ups
  • Ongoing infection
  • Pathological fracture
  • Growth disturbance + deformities
  • Squamous cell carcinoma
23
Q

What is the treatment of osteomyelitis?

A
  • Long term antibiotics (local or systemic)
  • Surgery
  • Treat soft tissue problems
  • Deformity correction?
  • Massive reconstruction?
  • Amputation?
24
Q

What are the routes of infection in acute septic arthritis?

A
  • Haematogenous
  • Eruption of bone abscess
  • Direct invasion: penetrating wound, intra-articular injury and arthroscopy
25
Q

What are the common organisms that cause acute septic arthritis?

A
  • Staph aureus
  • H. influenzae
  • E. coli
26
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 the articular cartilage
27
Q

What are the clinical features of acute septic arthritis in a neonate?

A

Picture of Septicaemia:

  • Irritability
  • Resistance to movement
  • Ill
28
Q

What are the clinical features of acute septic arthritis in a child or adult?

A
  • Acute pain in a single large joint
  • Reluctant to move the joint
  • Increased temp. and pulse
  • Increased tenderness
  • Adult: superficial joints (knee, ankle and wrist)
29
Q

How can acute septic arthritis be investigated?

A
  • FBC, WBC, ESR, CRP and blood cultures
  • XR
  • USS
  • Aspiration
30
Q

What is the most common cause of acute septic arthritis?

A

Infected joint replacement - staph aureus infection

31
Q

Name the differential diagnoses of acute septic arthritis?

A
  • Acute osteomyelitis
  • Trauma
  • Irritable joint
  • Haemophilia
  • Rheumatic fever
  • Gout
  • Gaucher’s disease
32
Q

What is the treatment of acute septic arthritis?

A
  • General supportive measures
  • Antibiotics (3-4 weeks)
  • Surgical drainage and lavage
33
Q

What are the classifications of TB in bones and joints?

A
  • Extra-articular (epiphyseal/ bones with haemodynamic marrow)
  • Intra-articular (large joints)
  • Vertebral body
34
Q

What are the clinical features of TB in bones and joints?

A

-Insidious onset and general ill health
-Contact with TB
Pain (esp. at night), swelling and loss of weight
-Low grade pyrexia
-Joint swelling
-Decreased ROM
-Ankylosis
-Deformity

35
Q

Describe the pathology of TB

A
  • Primary complex (lung or gut)
  • Secondary spread
  • Tuberculous granuloma
36
Q

What are the features of tuberculosis in the spinal?

A
  • Little pain

- Present with abscess or kyphosis

37
Q

Which features are diagnostic of tuberculosis in bones or joints?

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

How can TB in bones/joints be investigated?

A
  • FBC, ESR
  • Mantoux test
  • Sputum/urine culture
  • XR (soft tissue swelling, periarticular osteopaenia and articular space narrowing)
  • Joint aspiration and biopsy
39
Q

Name the differential diagnosis of TB in bones/joints

A
  • Transient synovitis
  • Monoarticular RA
  • Haemorrhagic arthritis
  • Pyogenic arthritis
  • Tumour
40
Q

What is the treatment of TB in bones/joints?

A
  • Rifampicin, Isoniazid and ethambutol for 8 weeks
  • Rifampicin and Isoniazid for 6-12 months
  • Rest and splintage

Musculo-skeletal (27 decks)

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