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Adele MSK > Bone & Joint Infection > Flashcards

Bone & Joint Infection Flashcards

1
Q

What is infection in bone known as?

A

Osteomyelitis

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2
Q

What are the organisms responsible for an osteomyelitis in an infant <1 year?

A

Staph aureus
Group B streptococci
E. coli

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3
Q

What are the organisms responsible for an osteomyelitis in a child?

A

Staph aureus
Strep pyogenes
Haemophilus influenzae

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4
Q

What are the organisms responsible for an osteomyelitis in an adult?

A 
Staph aureus
Coagulase negative staphylococci
Propionibacterium spp
Mycobacterium tuberculosis
Pseudomonas aeroginosa
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5
Q

What are the organisms responsible for an osteomyelitis in someone with sickle cell disease?

A

Salmonella spp

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6
Q

What is the process involved in an acute osteomyelitis?

A 
Starts at metaphysis
Vascular stasis (venous congestion &amp; arterial thrombosis)
Acute inflammation - increased pressure
Suppuration
Release of pressure
Necrosis of bone (sequestrum)
New bone formation (involucrum)
Resolution/chronic osteomyelitis
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7
Q

What are the clinical features of an acute osteomyelitis in an infant?

A 
May be minimal signs, or may be very ill
Failure to thrive
Possibly drowsy or irritable
Metaphyseal tenderness &amp; swelling
Decreased ROM
Positional change
Commonest around the knee
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8
Q

What are the clinical features of an acute osteomyelitis in a child?

A

Severe pain
Reluctant to move (neighbouring joints held flexed)
Not weight bearing
May be tender fever (swinging pyrexia) & tachycardia
Malaise (fatigue, nausea, vomiting)
Toxaemia

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9
Q

What are the clinical features of an acute osteomyelitis in an adult?

A

Primary OM seen commonly in thoracolumbar spine
Backache
History of UTI or urological procedure
Elderly, diabetic, immunocompromised

Secondary OM much more common
Often after open fracture, surgery (especially ORIF)

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10
Q

How is a diagnosis of acute osteomyelitis made?

A

History and clinical examination (pulse & temp)
FBC & diff WBC (neutrophil leukocytosis)
ESR, CRP
Blood cultures x3 (at peak of temp - 60% +ve)
U&Es

X-ray (normal in the first 10-14 days)
Ultrasound
Aspiration
Isotope bone scan (Tc-99, Gallium-67)
Labelled white cell scan (Indium-111)
MRI
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11
Q

What are the differential diagnoses for an acute osteomyelitis?

A 
Acute septic arthritis
Acute inflammatory arthritis
Trauma (fracture, dislocation, etc)
Transient synovitis ("irritable hip")
Rare
- Sickle cell crisis
- Gaucher's disease
- Rheumatic fever
- Haemophilia
Soft tissue infection
- Cellulitis
- Erysipelas
- Necrotising fasciitis
- Gas gangrene
- Toxic shock syndrome
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12
Q

How is a microbiological diagnosis of an acute osteomyelitis made?

A

Blood cultures in haematogenous osteomyelitis and septic arthritis
Bone biopsy
Tissue or swabs from up to 5 sites around implant at debridement in prosthetic infections
Sinus tract and superficial swab results may be misleading (skin contaminants)

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13
Q

What is the treatment for an acute osteomyelitis?

A

Supportive treatment for pain and dehydration
Rest and splintage
Antibiotics
- Route (IV/oral switch - 7-10 days?)
- Duration (4-6 weeks - depends on response, ESR)
- Choice - empirical (fluclox & benpen) while waiting

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14
Q

What are the indications for surgery in an acute osteomyelitis?

A

Aspiration of pus for diagnosis and culture
Abscess drainage (multiple drill-holes, primary closure to avoid sinus)
Debridement of dead/infected/contaminated tissue
Resistant to non-operative Rx >24-48 hours

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15
Q

What are the possible complications of an acute osteomyelitis?

A 
Septicaemia, death
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
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16
Q

What are the complications of a chronic osteomyelitis?

A

Chronically discharging sinus & flare ups
Ongoing (metastatic) infection (abscesses)
Pathological fracture
Growth disturbance & deformities
Squamous cell carcinoma (0.07%)

17
Q

What is the treatment for a chronic osteomyelitis?

A 
Long term antibiotics?
- Local (gentamicin cement/beads, collatamp)
- Systemic (orally/IV/home AB)
Eradicate bone infection - surgically (multiple operations
Treat soft tissue problems 
Deformity correction?
Massive reconstruction?
Amputation?
18
Q

What are the common organisms responsible for an acute septic arthritis?

A

Staphylococcus aureus
Haemophilus influenzae
Streptococcus pyogenes
E. coli

19
Q

What is the pathophysiology behind an acute septic arthritis?

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Complete destruction of the articular cartilage

20
Q

What is the most common cause of an acute septic arthritis in an adult?

A

Infected joint replacement

21
Q

What are the differential diagnoses for an acute septic arthritis?

A 
Acute osteomyelitis
Trauma
Irritable joint
Haemophilia
Rheumatic fever
Gout
Gaucher's disease

Adele MSK (22 decks)

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