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Year 3 > Bone and Soft Tissue Infections > Flashcards

Bone and Soft Tissue Infections Flashcards

1
Q

who gets acute osteomyelitis?

A 
children
boys
Hx of trauma
diabetes
RA
immune compromise
long term steroid treatment
sickle cell
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2
Q

source of acute osteomyelitis infection

A 
• Haematogenous spread – children and elderly
• Local spread from contiguous site of infection
o Trauma – open fracture
o Bone surgery – ORIF (open reduction internal fixation)
o Joint replacement
• Secondary to vascular insufficiency
• Infants
o Infected umbilical cords
• Children
o Boils
o Tonsillitis
o Skin abrasions
• Adults
o UTI
o Arterial line
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3
Q

organisms causing acute osteomyelitis: infants < 1

A

stap a
group B strep
e. coli

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4
Q

organisms causing acute osteomyelitis: older children

A

staph a
strep pyogenes
H. influenzae

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5
Q

organisms causing acute osteomyelitis: adults

A 
staph a
coagulase -ve staph (protheses)
propionibacterium spp (protheses)
mycobacterium tuberculosis
pseudomonas aeruginosa
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6
Q

organisms causing acute osteomyelitis: diabetic foot and pressure sores

A

mixed infection inc anaerobes

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7
Q

organisms causing acute osteomyelitis: sickle cell

A

salmonella spp

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8
Q

organisms causing acute osteomyelitis: fishermen, filleters

A

mycobacterium marinum

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9
Q

organisms causing acute osteomyelitis: HIV/AIDS

A

candida

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10
Q

pathophysiology of acute osteomyelitis

A
  • Starts at metaphysis
  • Vascular stasis (venous congestion + arterial thrombosis)
  • Acute inflammation – increased pressure
  • Suppuration
  • Release of pressure (medulla, sub-periosteal, into joint)
  • Necrosis of bone (sequestrum)
  • New bone formation (involucrum)
  • Resolution – or not
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11
Q

clinical features of acute osteomyelitis: infant

A 
minimal signs to very ill
failure to thrive
drowsy and irritably
metaphyseal tenderness + swelling
decrease ROM
positional change
comment around knee
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12
Q

clinical features of acute osteomyelitis: children

A 
severe pain
reluctant to move, not weight bearing
may be tender fever (swinging pyrexia) and tachycardia
malaise
toxaemia
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13
Q

clinical features of acute osteomyelitis: adults

A

primary OM in thoracolumbar spine:
back ache
Hx of UTI or urological procedure
elderly, diabetic, immunocompromised

secondary OM:
after open fracture, ORIF
mixture of organisms

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14
Q

diagnosis of acute osteomyelitis

A 
• Hx and clinical exam
o Pulse and temperature
• FBC + diff WBC (neutrophil leucocytosis)
• ESF, CRP
• Blood cultures x 3
• U+Es – ill, dehydrated
• X-ray (normal first 10-14 days)
o 10 – 20 days early periosteal changes
o Medullary changes – lytic areas
o Late osteonecrosis – sequestrum
o Late periosteal new bone – involucrum
• USS
• Aspiration
• Isotope bone scan (Tc-99, Gallium-67)
• Labelled white cell scan (Indium-111)
• MRI
• Microbiology
o Blood cultures in haematogenous osteomyelitis and septic arthritis
o Bone biopsy
o Tissue or swabs from up to 5 sites around implant at debridement in prosthetic
infections
o Sinus tract and superficial swab results may be misleading
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15
Q

DDx acute osteomyelitis

A 
• Acute inflammatory arthritis
• Trauma (fracture, dislocation etc)
• Transient synovitis (irritable hip)
• Rare
o Sickle cell crisis
o Gaucher’s disease
o Rheumatic fever
o Haemophilia
• Soft tissue infection
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16
Q

treatment of acute osteomyelitis

A

• Supportive treatment for pain and dehydration
o General care, analgesia
• Rest and splintage
• Antibiotics
o Route (IV/oral switch – 7-10 days)
o Duration (4-6 weeks depending on response, ESR_
o Choice – empirical (fluclox and benxylpen) while waiting
o Spectrum of activity
o Penetration to bone
o Safety for long term administration
• Surger

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17
Q

indications for surgery in acute osteomyelitis

A

§ Aspiration of pus for diagnosis & culture
§ Abscess drainage (multiple drill-holes, primary closure to avoid sinus)
§ Debridement of dead/infected /contaminated tissue
§ Refractory to non-operative Rx >24-48 hrs.
o Timing, drainage, lavage
o Infected joint replacement – one stage revision/two stage revision/antibiotics only?

18
Q

complications of acute osteomyelitis

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

chronic osteomyelitis causes

A

This may follow on from acute osteomyelitis, mow much rarer in children. However, it may also occur de novo: following operation, post open fracture (possibly many years ago), immunosuppressed, diabetics, elderly, drug abusers etc. May occur as a result of repeated breakdown of “healed” wounds.

20
Q

organisms causing chronic osteomyelitis

A

often mixed
usually same organism with each flar up
stap a, e. coli, strep pyogenes, proteus

21
Q

pathology of chronic osteomyelitis

A

cavities, possibly sinus
dead bone (retained sequestra)
involucrum
histological picture is one of chronic inflammation

22
Q

complication of chronic osteomyelitis

A

chronically discharging sinus + flare ups
ongoing (metastatic) infection (abscesses)
pathological fracture
growth disturbance + deformities
squamous cell carcinoma

23
Q

treatment of chronic osteomyelitis

A

long term antibiotics (gentamicin cement/beads)
surgically eradicate bone infections (multiple operations)
treat soft tissue problems
deformity correction
massive reconstruction
amputation

24
Q

acute septic arthritis: route of infection

A

haematogenous
eruption of bone abscess
direct invasion - penetrating wound, intra-articular injury, arthroscopy

25
Q

acute septic arthritis: organism

A

staph a
haemophilus influenzae
strep pyogenes
e. coli

26
Q

acute septic arthritis: pathophysiology

A

acute synovitis with purulent joint effusion
articular cartilage attacked by bacterial toxin and cellular enzyme
complete destruction of the articular cartilage

27
Q

acute septic arthritis: sequelae

A

complete recovery
partial loss of the articular cartilage and subsequent OA
fibrous or bony ankylosis

28
Q

acute septic arthritis: symptoms neonate

A

picture of septicaemia - irritability, resistant to movement, ill

29
Q

acute septic arthritis: child/adult symptoms

A

acute pain in single large joint
reluctant to move the joint
increased temp and pulse
increased tenderness

30
Q

acute septic arthritis: investigations

A

FBC, WBC, ESR, CRP, blood cultures
xray
USS
aspiration

31
Q

acute septic arthritis: DDx

A 
acute osteomyelitis
trauma
irritable joint
haemophilia
rheumatic fever 
gout
gaucher's disease
32
Q

acute septic arthritis: treatment

A

general supportive measures
antibiotics 3-4 wks
surgical drainage and lavage
infected joint replacements

33
Q

joint TB: classification

A

extra-articular - epiphyseal/bones with haemodynamic marrow)
intra-articular (large joints)
vertebral body

34
Q

joint TB: clinical features

A 
insidious onset and general health ill health
contact with TB
pain (night), swelling, loss of weight
low grade pyrexia
joint swelling
decrease ROM
ankylosis
deformity
35
Q

joint TB: pathology

A

primary complex in the lung or gut
secondary spread
tuberculous granuloma

36
Q

joint TB: what may spinal present like?

A

little pain

present with abscess or kyphosis

37
Q

joint TB: diagnosis

A 
long Hx
involvement of signle joint
marked thickening of the synovium
marked muscle wasting
periarticular osteoporosis
38
Q

joint TB: investigation

A 
FBC, ESR
mantoux test
sputum/urine culture
X-ray
joint aspiration and biopsy
39
Q

joint TB: DDx

A 
transient synovitis
monoarticular RA
haemorrhagic arthritis
pyogenic arthritis
tumour
40
Q

joint TB: treatment

A
  • Rifampicin, isoniazid, ethambutol, pyrazinamide – 8 weeks
  • Rifampicin and isoniazid – 6-12 months
  • Rest and splintage
  • Operative drainage rarely necessary

Year 3 (164 decks)

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