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Orthopedics > Bone Infection > Flashcards

Bone Infection Flashcards

1
Q

When is antibiotic prophylaxis used in orthopaedic surgery?

A

When metal work is involved

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2
Q

What are the commonest causes of acute osteomyelitis in children and adults?

A

Children:
Haematogenous spread

Adults:
Trauma or operation(rare)
Immunocompromised
- Diabetes
- Steroids 
IVDU
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3
Q

What are the most common causative organisms in acute haematogenous osteomyelitis?

A
  1. Staphylococcus aureus
  2. Streptococci
  3. Coliforms
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4
Q

How does acute haematogenous osteomyelitis typically present?

A
  1. Pain
  2. Tenderness
  3. Localised inflammation
  4. Fever
  5. Preceding history of
    - Superficial cut
    - Infected sore throat
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5
Q

What investigations are indicated for acute haematogenous osteomyelitis?

A
  1. X-rays:
    - Normal at first
    - Later: hazy edge to bone (periosteal reaction + new bone formation)
  2. Bone scan:
    - Show increased activity while X-rays still normal
  3. Bloods:
    - Culture
    - WCC / ESR / CRP all raised
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6
Q

How is acute haematogenous osteomyelitis treated?

A
  1. IV antibiotics
    - Oral after a few days
    - Up to 6 weeks
  2. Analgesia
  3. Rest
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7
Q

How is postoperative osteomyelitis with metalwork in situ treated?

A
  1. IV antibiotics
  2. Remove metalwork
  3. Replace with external fixator
    - If # not healed
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8
Q

What is a sequestrum?

A

An area of pus that is walled off by new bone, often discharging through a sinus.

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9
Q

What is chronic osteomyelitis?

A

Infection can remain for many years if a sequestrum forms - recurrent acute flare-ups. Surgical removal may be indicated.

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10
Q

What are common sites for acute septic arthritis?

A

Hip in children

Knee in adults

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11
Q

How does acute septic arthritis typically present?

A
  1. Systemically unwell: malaise, fever, rigors

2. Joint: painful, inflamed, swollen, restricted movement

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12
Q

How is acute septic arthritis diagnosed?

A

Dx based on clinical presentation

Confirmed by aspiration and analysis of aspirate (MC&S)

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13
Q

What investigations are indicated for acute septic arthritis?

A
  1. X-rays - normal initially
  2. US - joint effusion
  3. Aspiration
  4. Blood tests: FBC, ESR, CRP, cultures (TB)
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14
Q

True or false: TB can cause acute septic arthritis

A

True

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15
Q

How is acute septic arthritis treated?

A
  1. Joint washout under GA
  2. IV antibiotics
  3. Remove any metalwork
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16
Q

A patient presents with a hot swollen knee. The aspirate shows many white cells but no organisms. What is your differential diagnosis?

A
  1. Septic arthritis
  2. Acute monoarthritis (RA)
  3. Gout
  4. Pseudogout
17
Q

A patient presents with a hot swollen knee. The aspirate shows many white cells but no organisms. What else would you like to know?

A
  1. Does the patient feel generally well or unwell?
  2. Are they diabetic
  3. Are they on steroids? (Immunosupressed, AVN)
  4. Have they had any previous episodes?
18
Q

A patient presents with a hot swollen knee. The aspirate shows many white cells but no organisms. The blood markers are normal and the patient is apyrexial and looks well. How do you proceed?

A 
Septic arthritis is unlikely
Rx:
1. Splintage
2. Rest
3. NSAIDs

Admit for observation if in doubt

Orthopedics (18 decks)

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