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MSK clinical > Bone infections > Flashcards

Bone infections Flashcards

1
Q

in what age group and sex is acute osteomyelitis more common in?

A

children

boys > girls

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2
Q

what puts a patient at risk of acute osteomyelitis?

A 
immunocompromised
diabetes mellitus
sickle cell disease
long term steroid treatment 
rheumatoid arthritis
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3
Q

what are the 3 main sources of infection of acute osteomyelitis?

A

haematogenous spread from blood born infection
local spread from a contiguous infection
secondary to vascular insufficiency (necrotic distal limb = penetration of skin = organisms enter)

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4
Q

what are the main causes of blood born infections which can cause acute osteomyelitis?
(infants, children & adult)

A

infants - infected umbilical cord
children - boils, sinusitis, skin abrasions
adults - UTI, arterial line

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5
Q

what is the most common causative organism of acute osteomyelitis?

A

staph aureus

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6
Q

what is the most common causative organism for acute osteomyelitis in drug abusers ?

A 
pseudomonas aeroginosa
(also penetrating foot injuries)
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7
Q

what is the most common causative organism for acute osteomyelitis if the patient has sickle cell disease?

A

salmonella sp.

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8
Q

at what part of the bone does osteomyelitis start?

A

metaphysis

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9
Q

what are the medical terms for bone necrosis and bone formation?

A 
necrosis = sequestrum 
formation = involucrum
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10
Q

what are the signs of osteomyelitis in infants?

A 
failure to thrive
decreased range of movement
positional change
possibly drowsy, irritable
metaphysical tenderness + swelling
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11
Q

where is the commonest site of acute osteomyelitis in an infant?

A

around the knee

often occurs in multiple sites in infants

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12
Q

whats the presentation of acute osteomyelitis in a child?

A 
severe pain 
reluctant to move, not weight bearing, neighbouring joints held flexed
tender
swinging pyrexia
tachycardia
malaise (nausea, vomiting, fatigue)
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13
Q

what is the most common primary site of acute osteomyelitis in adults?

A

thoracolumbar spine

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14
Q

what is the most common causative organism of primary acute osteomyelitis in an adult?

A

staph aureus

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15
Q

what investigations would you carry out to diagnose acute osteomyelitis?

A 
history and examination
FBC & WCC
ESR, CRP 
blood cultures (x3) , bone biopsy
U&E
xray
USS
aspiration
isotope bone scan 
labelled white cell scan
MRI
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16
Q

what is the treatment duration of acute osteomyelitis?

A

4-6 weeks depending on the response and ESR

17
Q

what is the treatment for acute osteomyelitis?

A

supportive i.e. analgesia

rest and splintage

antibiotics i.e. flucloxacillin and benzylpenicillin (empirical awaiting microbiology)

surgery

18
Q

what are the complications of acute osteomyelitis?

A 
septic arthritis
pathological fractures 
septicaemia, death
altered bone growth 
chronic osteomyelitis 
metastatic infection
19
Q

what are the causes of chronic osteomyelitis?

A

follow acute osteomyelitis
following operation, open fracture
immunosuppressed
repeated breakdown of healed wounds

20
Q

what is the causative organism(s) of chronic osteomyelitis?

A

staph aureus, e.coli, staph progenies, proteus

21
Q

what are the complications from chronic osteomyelitis?

A

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

22
Q

what are the different treatment options for chronic osteomyelitis?

A 
long term antibiotics 
- local i.e. gentamicin cements, collatamp
- systemic i.e. oral, IV 
surgery (multiple)
treat soft tissue infections
correct deformity
amputation
23
Q

what are the routes of infection for acute septic arthritis?

A 
haematogenous
eruption of abscess
penetration 
- penetrating wound
- intra-articular injury 
- arthroscopy
24
Q

what are the common causative organisms of septic arthritis?

A

staph aureus
haemophillus influenzae
strep pyogenes
e.coli

25
Q

what is the pathology in acute septic arthritis?

A

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

26
Q

what is the sequelae of septic arthritis?

A

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

27
Q

what is the presentation of septic arthritis in children/adults?

A

acute pain in a single large joint

  • reluctant to move the joint in any movement
  • increased temp and pulse
  • increased tenderness
28
Q

what is the commonest cause of septic arthritis in an adult?

A

infected joint replacement

29
Q

what is the most common causative organism that causes septic arthritis from infected joint replacement ?

A

staph epidermidisis

30
Q

what is the treatment for acute septic arthritis?

A

supportive measures
antibiotics (if pus then surgical)
surgical drainage and lavage
1 or 2 stage revision of infected joint replacement

31
Q

what are the classifications of TB in bone and joints?

A

extra-articular
intra-articular
vertebral body

32
Q

what is the commonest side of TB bone and joints?

A

vertebral body

33
Q

what are the clinical features of joint and bone TB?

A 
insidious onset and general ill health
pain, swelling, loss of weight 
low grade pyrexia 
joint swelling 
decreased range of movement 
ankylosis 
deformity
contact with TB
34
Q

what is the presentation of spinal TB?

A

present with little pain

present with abscess or kyphosis

35
Q

what are the diagnostic features of bone and joint TB?

A

involvement of single joint
marked thickening of synovium
marked muscle wasting
periarticular osteoporosis around the joint

36
Q

what investigations are carried out to diagnose joint and bone TB?

A 
FBC, SR
mantoux test
sputum/urine culture
aspiration
xray
37
Q

what is the treatment for joint and bone TB?

A

chemotherapy: rifampicin, isoniazid, ethambutol (8 weeks) then rifampicin and isoniazid (6-12 months)
rest and spintage
operative drainage

MSK clinical (25 decks)

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