Bone & Soft Tissue Infection Flashcards

1
Q

What is infection of the bone referred to as?

A

Osteomyelitis

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2
Q

How is osteomyelitis classified?

A

1) Acute
2) Chronic
1) Specific (e.g. TB)
2) Non-specific (most common)

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3
Q

What is the pathological process involved in bone infection?

A
  • Spreads from metaphysis (possibly caused by trauma?)
  • Leukocytes release enzymes which lyse the bone
  • Spread of infection from metaphysis results in venous congestion and arterial thrombosis
  • Acute inflammation occurs as a result of the infection and produces increased pressure
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4
Q

What is the most common bacteria involved in acute osteomyelitis?

A

Staph Aureus

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5
Q

What are the common sources of infection in osteomyelitis?

A

1) Spread via blood
2) Local spread from site of infection - trauma, bone surgery
3) Vascular insufficiency

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6
Q

What is the aetiology of acute osteomyelositis?

A

Acute osteomyelitis:

  • Mostly children
  • Boys > girls
  • History of trauma
  • Common with other diseases (diabetes, RA, immune compromised, long-term steroids)
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7
Q

What are the common bacterias involved in chronic osteomyelitis?

A
  • Staph Aureus
  • E. Coli
  • Strep Pyogenes
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8
Q

What are the clinical features of an infant with osteomyelitis?

A

1) Failure to thrive
2) Metaphyseal tenderness + swelling
3) Decreased range of motion
4) Knee most commonly affected

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9
Q

What are the clinical features of a child with osteomyelitis?

A

1) Severe pain
2) Reluctant to move and not weight bearing
3) Fever and tachycardia
4) Malaise

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10
Q

What are the clinical features of an adult with osteomyelitis?

A

1) Commonly seen in thoracolumbar spine (primary)
2) Backache
3) History of UTI
4) Elderly, diabetic, immunocompromised
5) Secondary OM after open fractures or surgery

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11
Q

What are the differential diagnosis of acute osteomyelitis?

A

1) Acute septic arthritis
2) Acute inflammatory arthritis
3) Trauma
4) Transient synovitis
5) Soft tissue infection

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12
Q

What are the clinical features of acute septic arthritis in a neonate?

A

1) Irritability
2) Resistant to movement
3) ill

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13
Q

What are the clinical features of acute septic arthritis in a child/adult?

A

1) Acute pain in single large joint
2) Reluctance to move joint
3) Increased temperature and pulse
4) Increased tenderness

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14
Q

What are the differential diagnosis of acute septic arthritis?

A

1) Acute osteomyelitis
2) Trauma
3) Haemophilia
4) Rheumatic fever
5) Gout

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15
Q

What are the investigations and expected results of acute osteomyelitis?

A

1) Clinical examination - raised temp and pulse
2) ESR, CRP - raised
3) FBC - Raised neutrophils
4) Blood cultures - +ve
5) U+E’s - dehydrated

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16
Q

What are the investigations and expected results of septic arthritis?

A

1) FBC, WBC, ESR, CRP, Blood cultures
2) Radiograph
3) USS
4) Aspiration

17
Q

What are the principles of management of bone and soft tissue infections?

A

1- Supportive treatment for pain + dehydration (general care, analgesia)

2 - Rest + splintage

3) Antibiotics
4) Surgery

18
Q

What are the possible complications of bone and soft tissue infections?

A

1 - Septicaemia, death

2 - Metastatic infection

3 - Pathological fracture

4 - Septic arthritis

5 - Altered bone growth

6 - Chronic osteomyelitis

19
Q

What are the medical names for necrotised and new bone?

A
  • Necrotised bone is known as sequestrum
  • New bone formed is known as involucrum
20
Q

What is the aetiology of chronic osteomyelitis?

A

Chronic osteomyelitis:

  • Can follow acute osteomyelitis
  • May start on its own (e.g. post-operative)
  • Breakdown of healed wounds
21
Q

Is secondary or primary acute osteomyelitis more common?

A

Secondary

22
Q

At what stage in acute osteomyelitis will x-rays begin to show abnormalities?

A

10 days onwards