Bone and Soft Tissue Infection Flashcards
What is osteomyelitis?
Bone infection
Risk factors of osteomyelitis
Mostly children Boys > girls History of trauma Other disease - Diabetes - Rheumatoid arthritis - Immune compromise - Long term steroid treatment - Sickle cell
Osteomyelitis source of infection
Haematogenous spread
Local spread from contiguous site of infection – trauma
Secondary to vascular insufficiency
Acute osteomyelitis organisms < 1 year
Staph aureus
Group B streptococci
E. coli
Acute osteomyelitis organisms older children
Staph aureus
Strep pyogenes
Haemophilus influenzae
Acute osteomyelitis organisms adults
Staph aureus
Acute osteomyelitis pathology
Starts at metaphysis
Acute inflammation – increased pressure
Necrosis of bone
New bone formation
Presentation of acute myelitis (infant)
May be minimal signs, or may be very ill Failure to thrive Poss. drowsy or irritable Metaphyseal tenderness + swelling Decrease ROM Positional change Commonest around the knee
Presentation of acute myelitis (child)
Severe pain Reluctant to move Fever + tachycardia Malaise Toxaemia
Presentation of acute myelitis (adult)
Primary OM seen commonly in thoracolumbar spine
Backache
History of UTI or urological procedure
Elderly, diabetic, immunocompromised
Soft tissue infection
Cellulitis Erysipelas Necrotising fasciitis Gas gangrene Toxic shock syndrome
Acute osteomyelitis diagnosis
X-ray
Ultrasound
Aspiration
MRI
Sequestrum
Late osteonecrosis
Involucrum
Late periosteal new bone
Acute osteomyelitis
Supportive treatment for pain and dehydration
Rest & splintage
Antibiotics
Surgery
Chronic osteomyelitis organisms
Often mixed
mostly: Staph. Aureus E. Coli Strep. pyogenes Proteus
Chronic osteomyelitis treatment
Long-term antibiotics
Eradicate bone infection- surgically
Treat soft tissue problems
What is septic arthritis?
Joint infection
Acute septic arthritis route of infection
Haematogenous Eruption of bone abscess Direct invasion - Penetrating wound - Intra-articular injury - Arthroscopy
Septic arthritis organisms
Staphylococus aureus
Haemophilus influenzae
Streptococcus pyogenes
E. coli
Acute septic arthritis pathology
Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Complete destruction of the articular cartilage
Acute septic arthritis sequelae
Complete recovery
Partial loss of the articular cartilage and subsequent OA
Fibrous or bony ankylosis
Neonatal presentation of acute septic arthritis
Picture of septicaemia =>
Irritability
Resistant to movement
Ill
Child/adult presentation of acute septic arthritis
Acute pain in single large joint
Reluctant to move the joint
Increase temp. and pulse
Increase tenderness
What is the most common cause of acute septic arthritis in adults?
Infected joint replacement
Acute septic arthritis treatment
General supportive measures
Antibiotics
Classification of TB bone and joint
Extra-articular (epiphyseal / bones with haemodynamic marrow)
Intra-articular (large joints)
Vertebral body
TB clinical presentation
Insidious onset & general ill health Contact with TB Pain (esp. at night), swelling, loss of weight Low grade pyrexia Joint swelling Decrease ROM Ankylosis Deformity
TB pathology
Primary complex (in the lung or the gut)
Secondary spread
Tuberculous granuloma
Spinal tuberculosis presentation
Little pain
Present with abscess or kyphosis
