Bone and soft tissue infection Flashcards
What is osteomyelitis?
Bone infection
What is septic arthritis?
Joint infection
Does acute osteomyelitis mostly affect girls or boys?
Boys
What are some sources of an acute osteomyelitis infection?
Haematogenous
Local spread from contiguous infection site
Secondary to vascular insufficiency
What is the most common source of osteomyelitis infection for children and the elderly?
Haematogenous
What are some common causative organisms in acute osteomyelitis?
Staph aureus
Group B streptococci
Strep pyogenes
Haem influenzae
What is the sequence of events in the pathology of osteomyelitis?
Metaphysis (Trauma?) Vascular stasis Acute inflammation Increased pressure Suppuration Release of pressure Necrosis of bone New bone formation Resolution/Not
How may acute osteomyelitis present in infants?
Failure to thrive Drowsy Irritable Metaphysal tenderness < ROM
How may acute osteomyelitis present in a child?
Severe pain Reluctant to move Tender fever Tachycardia Malaise Toxaemia
How may acute osteomyelitis present in an adult?
Thoracolumbar spine
Backache
History of UTI or urological procedure
Diabetic/elderly
What are some useful tests for acute OM diagnosis?
FBC WBC ESR CRP Blood cultures U&Es
What are some useful imaging techniques for acute OM diagnosis?
X-ray US Aspiration Isotope bone scan Labelled white cell scan MRI
How is acute OM treated?
Supportive for pain and dehydration
Rest splintage
IV/Oral Fluclox + BenzylPen
How may OM become chronic?
Following operation
Following open wound
Immunosuppressed
Repeated breakdown of healed wounds
What are some routes of infection in acute septic arthritis?
Haematogenous
Eruption of bone abscess
Direct invasion
What are some common causative organisms in acute septic arthritis?
Staph aureus
Haemophilus influenzae
Strep pyogenes
E. coli
What is the pathological process in acute septic arthritis?
Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Complete destruction of the articular cartilage
How common are multiple lesions in TB patients?
1/3 patients affected
What are some clinical features of TB?
Insidious onset Contact with TB Pain Swelling Weight loss Low grade pyrexia < ROM Ankylosis
What is ankylosis?
Immobility and consolidation of a joint due to disease, injury, or surgical procedure
What are some diagnostic features of TB?
Long history Involvement in single joint Marked thickening of synovium Marked muscle wasting Periarticular osteoperosis
What are some useful investigations for TB?
FBC ESR Mantoux test X-ray Joint aspiration and biopsy
What would an x-ray highlight in TB?
Soft tissue swelling
Periarticular osteopaenia
Articular space narrowing
How is TB treated?
Chemotherapy Rifampicin Isoniazid W/ ethambutol for 8 weeks then just the other 2 for 6-12 months Rest and splintage Drainage if necessary
