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Yr 3 MSK > Bone and soft tissue infections > Flashcards

Bone and soft tissue infections Flashcards

1
Q

What is osteomyelitis?

A

Bone infection. Can be acute or chronic. Either specific (eg TB) or non-specific (most common)

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2
Q

In acute osteomyelitis when is it more common?

A
  • Mostly in children
  • Boys>girls
  • Trauma history
  • Other disease (DM, rheum arthritis, immunocompromised, steroid treatment, sickle cell)
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3
Q

What are the different sources of infection? What typically causes infection in infants, children and adults?

A
  • Haematogenous spread - children and elderly
  • Local spread from contiguous infection site: trauma (open #), bone surgery (ORIF), joint replacement
  • Secondary to vascular insufficiency

In infants: infected umbilical cord
In children: boils, tonsilitis, skin abrasions
In adults: UTI, arterial line

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4
Q

In infants <1y what are the causative organisms of acute osteomyelitis?

A
  • Staph aureus
  • Group B Streptococci
  • E. coli
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5
Q

In older children what are the causative organisms of acute osteomyelitis?

A
  • Staph aureus
  • Strep pyogenes
  • Haemophilus influenzae
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6
Q

In adults what are the causatuve organisms of acute osteomyelitis?

A
  • Staph aureus
  • Coagulase -ve staph (prostheses)
  • Mycobacterium tuberculosis
  • Pseudomonas aeroginosa (esp secondary to penetrating foot injuries, IVDA)
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7
Q

Likely causative organism of acute osteomyelitis in

  • Diabetic foot/pressure sores
  • Sickle cell disease
  • Fishermen
  • HIV/AIDS patients
A
  • Diabetic foot: mixed
  • Sickle cell: salmonella spp
  • Fishermen: Mycobacterium marinum
  • HIV/AIDS: Candida
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8
Q

What long bones (metaphysis) are acute osteomyelitis likely to start?

A
  • Distal femur
  • Proximal tibia
  • Proximal humerus
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9
Q

What joints with intra-articular metaphysis are acute osteomyelitis likely to start?

A
  • Hip

- Elbow (radial head)

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10
Q

What is the pathology of acute osteomyelitis?

A
  • Starts at metaphysis
  • Vascular stasis (venous congestion+arterial thrombosis)
  • Acute inflammation, suppuration, release of pressure
  • Necrosis of bone (sequestrum)
  • New bone formation (involcrum)
  • Resolution (or not - chronic osteomyelitis)
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11
Q

Clinical features of acute osteomyelitis in infants?

A
  • May be minimal/very ill
  • Fail to thrive
  • Drowsy or irritable
  • Metaphyseal tenderness and swelling
  • Dec. ROM
  • Position change
  • Commonest around knee
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12
Q

Clinical features of acute osteomyelitis in children?

A
  • Severe pain
  • Reluctant to move (neighbouring joints flexed), no weight bearing
  • Tender fever (swinging pyrexia) and tachycardia
  • Malaise (fatigue, nausea, vomiting)
  • Toxaemia
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13
Q

Clinical features of acute osteomyelitis in adult?

A
  • More common in thoracolumbar spine (primary OM)
  • Backache
  • UTI/urological procedure history
  • Elderly, DM, immunocompromised
  • Secondary OM more common (open #, surgery etc)
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14
Q

Diagnosing acute osteomyelitis?

A
  • History and exam (pulse+temp)
  • FBC and WBC
  • ESR and CRP
  • Blood culture
  • U and Es
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15
Q

Diff diagnosis of acute OM?

A
  • Acute septic arthritis
  • Acute inflammatory arthritis
  • Trauma
  • Transient synovitis
  • Rare (sickle cell, Gauchers, rheumatic fever, haemophilia)
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16
Q

What soft tissue infections are differential diagnoses of acute OM?

A
  • Cellulitis (Gp A strep)
  • Erysipelas (Gp A strep)
  • Necrotising fasciitis (gp A strep, clostridia)
  • Gas gangrene (clostridium perfringens)
  • TSS (staph aureus)
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17
Q

Investigations for acute OM?

A

-X-ray
-USS
-Aspirate
Isotope bone scan
-Labelled white cell scan
-MRI

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18
Q

Look on slide 21 for radiograph changes

A

:p

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19
Q

How do you use microbiology to diagnose acute OM?

A
  • Blood cultures
  • Bone biopsy
  • Tissue or swabs at debridement if any
  • Sinus tract, superficial swabs (may be misleading)
20
Q

Treatment for acute OM?

A
  • Supportive (analgesia, rest, splintage)

- Antibiotics (IV/oral, 4-6wks, Fluclox/benzylpen while waiting)

21
Q

Why do antibiotics fail in acute OM?

A
  • Drug resistance
  • Bacterial resistance (dormancy)
  • Poor host defences
  • Poor drug absorption
  • Drug inactivation by host flora
  • Poor tissue penetration
22
Q

Indications for surgery on acute OM?

A
  • Aspiration of pus
  • Abscess drainage
  • Debridement of dead/infected/contaminated tissue
  • Refractory to non-operative Rx
23
Q

Complications of acute OM?

A
  • Septicaemia, death
  • Metastatic infection
  • Pathological #
  • Septic arthritis
  • Altered bone growth
  • Chronic osteomyelitis
24
Q

When may chronic OM occur?

A
  • May follow acute OM
  • De novo (following op/open #, immunosuppressed, DM, elderly, IVDA etc)
  • Repeated breakdown of healed wounds
25
Q

Organism in chronic OM?

A
  • Usually same organisms each flare up

- Usually staph aureus, e. coli, strep pyogenes, Proteus

26
Q

Pathology in chronic OM?

A
  • Cavities, poss. sinuses
  • Dead bone
  • Involucrum
  • Chronic inflammation on histology
27
Q

Complications of chronic OM?

A
  • Chronically discharging sinus and flare ups
  • Ongoing metastatic infection
  • Pathological #
  • growth disturbance and deformities
  • SCC
28
Q

Treatment of chronic OM?

A
  • Local/systemic antib (gentamicin cement, orally, IV)
  • Surgically remove bone infection
  • Soft tissue problems
  • Correct deformities
  • Amputation
29
Q

Route of infection in acute septic arthritis?

A
  • Haematogenous
  • Erupting bone abscess
  • Penetrating wound/intra-articular injury/arthroscopy (direct invasion)
30
Q

Common organisms in acute septic arthritis?

A
  • Staph aureus
  • Haemo. influenzae
  • Strep pyogenes
  • E. coli
31
Q

Pathology in acute septic arthritis?

A
  • Acute synovitis with purulent joint effusion
  • Articular cartilage attacked by bacterial toxin and cellular enzyme
  • Destruction of articular cartilage
32
Q

Sequelae of acute septic arthritis?

A
  • Recovery or
  • Partial loss of articular cartilage and subsequent OA or
  • Fibrous or bony ankylosis
33
Q

Picture of acute septic arthritis in infant?

A

Septicaemia picture

  • Irritable
  • Won’t move
  • Ill
34
Q

Picture of acute septic arthritis in child/adult?

A
  • Reluctant to move joint

- Inc temp, tenderness and pulse

35
Q

Investigations of acute septic arthritis?

A
  • FBC, WBC, ESR, CRP, blood culture
  • X ray
  • USS
  • Aspirate
36
Q

Commonest cause of acute septic arthritis?

A

Infected joint replacement (Staph aurerus most common)

37
Q

Differential diagnosis of acute septic arthritis?

A
  • Acute OM
  • Trauma
  • Irritable joint
  • Haemophilia
  • Rheumatic fever
  • Gout
  • Gauchers disease
38
Q

Treatment of acute septic arthritis?

A
  • Supportive measures
  • Antibiotics 3-4w
  • Surgical drainage and lavage
39
Q

Classification of areas affected by TB?

A
  • Extra-articular
  • Intra-articular
  • Vertebral body
40
Q

Clinical features of TB in bone/joint?

A
  • Malaise
  • TB contact
  • Pain (esp night), swelling, weight loss
  • Low grade pyrexia
  • Dec. ROM
  • Ankylosis
  • Deformity
41
Q

TB pathology?

A
  • Primary complex (lung or gut)
  • Secondary spread
  • Tuberculous granuloma
  • Role of nutrition/other disease (eg HIV/AIDS)
42
Q

Spinal symptoms of TB?

A
  • Little pain

- Present with abscess or kyphosis

43
Q

Diagnosing TB?

A
  • History
  • Involving single joint
  • Thickening of synovium
  • Muscle wasting
  • Periarticular osteoporosis
44
Q

Investigating TB?

A 
-FBC, ESR
Mantoux test
-Sputum/urine culture
-Xray
-Aspirate and biopsy joint
45
Q

Diff diagnosis of TB?

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

Treatment of TB?

A

Chemo

  • RIPE (remember from 2nd year)
  • Rest
  • Operative drainage if needed

Yr 3 MSK (12 decks)

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