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MSK > Bone and Soft tissue infection > Flashcards

Bone and Soft tissue infection Flashcards

1
Q

What is a bone infection called?

A

Osteomyelitis

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2
Q

What is a joint infection called?

A

Septic arthritis

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3
Q

Classes of osteomyelitis

A

Acute
Chronic
Specific (E.g. TB)
Non-specific (most common)

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4
Q

Most common type of osteomyelitis

A

Non-specific

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5
Q

Who does acute osteomyelitis mostly affect?

A

Children (different ages)

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6
Q

Do boys or girls get acute osteomyelitis more?

A

Boys > girls

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7
Q

Associations/things likely in the history with acute osteomyelitis

A 
History of minor trauma 
Diabetes
Rheumatoid arthritis 
Immunocompromised
Long term steroid treatment 
Sickle cell
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8
Q

Source of infection in acute osteomyelitis

A 
Haematogenous spread (elderly and children)
Local spread from contiguous site of infection e.g. 
- trauma
- bone surgery (ORIF)
- joint replacement 
Secondary to vascular insufficiency 
Infected umbilical cord in infants
In children
- boils
- tonsillitis 
- skin abrasions
Adults
- UTI
- Urinary catheter
- arterial line
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9
Q

Most common source of infection in acute osteomyelitis

A

Haematogenous spread

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10
Q

Causative organisms of acute osteomyelitis

A 
Infants < 1 year 
- E coli ( most common )
- Staph aureus 
- group B streptococci 
Older children
- Staph aureus ( most common )
- Strep pyogenes
- haemophilus influenzae
Adults
- staph aureus ( most common )
- protheses; coagulase -ve streptococci 
- mycobacterium TB
- pseudomonas aeruginosa (esp. 2ndry to penetrating foot injuries, IVDAs)
Diabetic foot and pressure sores
- mixed infection including anaerobes 
Sickle cell disease
- salmonella
Fishermans and filleters 
- mycobacterium marinum 
Candida 
- debilitating illness
- HIV AIDs
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11
Q

Pathology of acute osteomyelitis

A
  1. starts of metaphysis (possible role of trauma - bruising/damage)
  2. Vascular stasis (venous congestion + arterial thrombosis)
  3. Acute inflammation - increased pressure
  4. Suppuration - a lot of pus
  5. Release of pressure - put breaks out (medulla, sub-periosteal, into joint)
  6. Necrosis of bone (sequestrum)
  7. New bone formation (involucrum)
  8. Resolution (or not - chronic osteomyelitis)
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12
Q

Causes of chronic osteomyelitis

A

Following acute osteomyelitis
Following operation
Following open fracture (possibly many years earlier)

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13
Q

Risk factors for chronic osteomyelitis

A 
Acute osteomyelitis 
Surgery 
Open fracture
Immunosuppressed
Diabetes
Elderly
Drug abusers
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14
Q

Organisms that cause chronic osteomyelitis

A 
Often mixed infection with the same organisms causing each flare up (usually)
Staph aureus
E. coli 
Strep pyogenes
Proteus
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15
Q

Pathology of chronic osteomyelitis

A

Cavities, possible sinus(es)
Dead bone (retained sequestra)
Involucrum
Histological picture of chronic inflammation

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16
Q

Route of infection of septic arthritis

A 
Haematogenous 
Eruption of bone abscess
Direct invasion  
- penetrating wound
- intra-articular injury 
- arthroscopy
- infected joint replacement 
Metaphyseal septic focus
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17
Q

Most common cause of septic arthritis in adults

A

Infected joint replacement

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18
Q

Causative organisms of septic arthritis

A

Staph aureus
Haemophilus influenzae
Strep pyogenes
E. coli

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19
Q

Pathology of septic arthritis

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Completed destruction of articular cartilage (result of acute septic arthritis)

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20
Q

What happens after septic arthritis?

A

Complete recovery
OR
Partial loss of articular cartilage and subsequent OA OR
Fibrous or bony ankylosis

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21
Q

Classification of bone and joint TB

A

Extra-articular (epiphyeal/bones with haemodynamic marrow)
Intra-articular (large joints)
Vertebral body

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22
Q

How many bone and joint TB infections have multiple lesions?

A

1/3rd

23
Q

Pathology of bone and joint TB

A

Primary complex (in lung or gut)
Secondary spread
TB granuloma
Note role of nutrition/other disease e.g. AIDs

24
Q

Presentation of acute osteomyelitis in infants

A 
Minimal signs or very ill 
Failure to thrive
Drowsy/irritable
Metaphyseal tenderness and swelling 
decreased ROM - tough to know if small baby 
Positional change
Commonest around knees
25
Q

Meaning of ROM

A

Range of movement

26
Q

Commonest site of acute osteomyelitis in infants

A

Around the knee

27
Q

Presentation of acute osteomyelitis in a child

A 
Severe pain 
Reluctant to move
Neighbouring joints held flexed 
Not weight bearing 
Tender fever (swinging pyrexia)
Tachycardia
Malaise 
Fatigue 
Nausea, vomiting 
Toxaemia
28
Q

Where in adults is primary osteomyelitis most commonly seen?

A

Thoracolumbar spine

29
Q

When does secondary osteomyelitis occur in adults?

A

Iatrogenic (especially ORIF)

Open fracture

30
Q

Presentation of acute osteomyelitis in adults

A

Backache
Temperature
History of UTI/urological procedure

31
Q

Acute primary osteomyelitis in adults Is commonly seen in who?

A

Elderly
Diabetic
Immunocompromised

32
Q

Presentation of acute septic arthritis in the neonate

A

Picture of septicaemia

  • irritability
  • resistant to movement
  • ill
33
Q

Presentation of child/adult acute septic arthritis

A

Acute pain in a single large joint
Reluctant to move joint - ANY movement
Increased temp and pulse
Increased tenderness

34
Q

What joints are usually affected in adult septic arthritis?

A

Superficial joints (knee, ankle, wrist)

35
Q

How common is septic arthritis in a healthy adult?

A

Rare

36
Q

Presentation of bone and joint TB

A 
Insidious onset with general ill health 
Contact with TB
Presentation (especially at night)
Swelling
Loss of weight
Low grade pyrexia 
Decreased ROM
Ankylosis
Spinal (little pain, present with abscess or kyphosis)
37
Q

Definition of ankylosis

A

Abnormal stiffening and immobility of a joint due to fusion of bones

38
Q

Investigations of acute osteomyelitis

A 
FBC and different WCC (neutrophil leucocytes)
Raised ESR and CRP
Blood cultures (x3) if haematogenous osteomyelitis and septic arthritis 
U and Es
Imaging 
- Xray 
- USS
- Aspiration 
- isotope bone scan
- labelled white cell scan 
- MRI
Bone biopsy 
Tissue or swabs from up to 5 sites around the implant at debridement in prostetic infections
39
Q

Differential diagnosis of acute osteomyelitis

A

Acute septic arthritis
Acute inflammatory arthritis
Trauma (fracture, dislocation)
Transient synovitis in children (“irritable hip”)
Soft tissue infection
- cellulitis, erysipelas, necrotising fasciitis, gas gangrene, TSS
Rare - haemophilia, sickle cell crisis, rheumatic fever

40
Q

What is gas gangrene?

A

Grossly contaminated trauma

41
Q

What Is gas gangrene caused by?

A

Clostridium perfringes

42
Q

Investigations of acute septic arthritis

A

FBC, WBC, ESR, CRP, blood cultures
X ray
USS
aspiration

43
Q

Differential diagnosis for acute septic arthritis

A 
Acute osteomyelitis 
Trauma
Irritable joint
Haemophilia 
Rheumatic fever
Gout
Gaucher's disease
44
Q

Bone and joint TB investigations

A 
Long history 
Involvement of a single joint
Marked muscle wasting
FBC, ESR
Mantoux test
Sputum/urine culture
Xray 
Joint aspiration and biopsy
45
Q

Bones and joint TB differential diagnosis

A 
Transient synovitis 
Monoarticular RA
Haemorrhagic arthritis
Pyogenic arthritis
Tumour
46
Q

Treatment of acute osteomyelitis

A

Supportive treatment for pain and dehydration (general care and analgesia)
Rest and splintage
Antibiotics (very high dose) for 4-6 weeks depending on response - flucloxacillin and benzylpenicillin
Surgery

47
Q

Why do antibiotics fail?

A 
Drug resistance e.g. B lactamases 
Bacterial persistence - 'dormant' bacteria in dead bone
Poor host defences - IDDM, alcoholism 
Poor drug absorption 
Drug inactivation by host flora 
Poor tissue penetration
48
Q

Treatment of chronic osteomyelitis

A 
Long term antibiotics 
Eradicate bone infection surgically 
Treat soft tissue problems 
Deformity correction 
Amputation
49
Q

Treatment of acute septic arthritis

A

General supportive measures
Antibiotics 3-4 weeks
Surgical drainage and lavage

50
Q

What responds better to antibiotics, joints or bones?

A

Joints

51
Q

Treatment of bone and joint TB

A 
Initial for 8 weeks
- rifampicin 
- isoniazid 
- ethambutol 
Then for 6-12 months
- rifampicin and isoniazid
Rest and splintage
Operative drainage - rarely needed
52
Q

Complications of acute osteomyelitis

A

Septicaemia leading to death
Metastatic infection
Pathological fracture (due to weakened bones)
Septic arthritis
Chronic osteomyelitis
Altered bone growth (especially in children)

53
Q

Complications of chronic osteomyelitis

A 
Chronically discharging sinus plus flare ups
ongoing metastatic infection (abscesses)
pathological fracture
Growth disturbance and deformities 
Squamous cell carcinoma (0.07%)

MSK (25 decks)

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