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MSK AM > Infection in bone and joints > Flashcards

Infection in bone and joints Flashcards

1
Q

What is osteomyelitis?

A

Bone infection

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2
Q

Who is acute osteomyelitis most often seen in?

A

Young boys with a history of minor trauma

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3
Q

What conditions is osteomyelitis associated with?

A 
Diabetes
Rheumatoid arthritis
Immune compromised
Long term steroids
Sickle cell
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4
Q

What are the causes of osteomyelitis?

A

Haematenogous spread
Local spread
Secondary to vascular insufficiency

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5
Q

What can development of osteomyelitis in infants be caused by?

A

Infected umbilical cord

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6
Q

What can development of osteomyelitis in children be caused by?

A

Boils and abrasions

Tonsilitis

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7
Q

What can development of osteomyelitis in adults be caused by?

A

UTI

Arterial line

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8
Q

Who is haematogenous spread of acute osteomyelitis seen in?

A

Mostly children and elderly

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9
Q

What are the causes of local spread of osteomyelitis?

A

Trauma- open fracture
Bone surgery
Joint replacement

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10
Q

What is the most common causative organisms of osteomyelitis?

A

Staph aureus

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11
Q

What are the bacterial causes of acute osteomyelitis in infants?

A

Staph aureus
Group B strep
E. coli- most common in <1 month olds

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12
Q

What are the bacterial causes of acute osteomyelitis in children?

A

Staph aureus
Strep pyogenes
H. influenzae

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13
Q

What are the bacterial causes of osteomyelitis in adults?

A

Staph aureus
Coag - staph with prothesis
Mycobacterium TB
Pseudomonas aeroginosa in penetrating injury

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14
Q

What can cause osteomyelitis in someone with sickle cell disease?

A

Salmonella species

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15
Q

What can cause osteomyelitis in someone with HIV/AIDS?

A

Candida

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16
Q

What causes osteomyelitis most often in diabetic foot disease?

A

Mixed, including anaerobes

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17
Q

Where does osteomyelitis most often occur?

A

Metaphysis of long bones- distal femur, proximal tibia, proximal humerus…
Joints with intra-articular metaphysics- hip, elbow

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18
Q

What is the process of osteomyelitis?

A 
Starts at metaphysis
Vascular stasis
Acute inflammation
Suppration (pus formation)
Release of pressure
Necrosis of bone
New bone formation
REsolution
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19
Q

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

A 
May be minimal signs, may be very ill
Failure to thrive
Drowsy, irritable
Metaphyseal tenderness or swelling
Decreased range of movement
Positional change
Commonest around knee
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20
Q

What are the clinical features of acute osteomyelitis in children?

A 
Severe pain
Reluctant to move, not weight bearing
Swinging pyrexia
Tachycardia
Malaise
Toxaemia
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21
Q

What are the clinical features of primary osteomyelitis in adults?

A

Thoracolumbar spine
Backache, pyrexia, history of UTI or urological procedure
Elderly, diabetic, immunocompromised

22
Q

What are the clinical features of secondary osteomyelitis in adults?

A

Often after open fracture or surgery
Mixture of organisms
More common

23
Q

How is osteomyelitis diagnosed?

A 
History and examination
Bloods
Microbiology
Xray
US
Aspiration
Isotope bone scan
Labelled white cell scan MRI
24
Q

What bloods are done for suspected osteomyelitis?

A

FBC, WCC
ESR, CRP
Blood cultures x3
U&E

25
Q

What can be seen on xray with osteomyelitis?

A

In first 2 weeks, little
10-20 days- early periosteal changes
Medullary changes

26
Q

What us the differential for acute osteomyelitis?

A 
Acute septic arthritis
Acute inflammatory arthritis
Trauma
Transient synovitis
Soft tissue infection
27
Q

What is the treatment of acute osteomyelitis?

A

Supportive
Rest and splint
Antibiotics- IV or oral for 4-6 weeks
Surgery

28
Q

What are the indications for surgery in acute osteomyelitis?

A

Aspiration of pus for diagnosis and culture
Abscess drainage
Debridement of dead, infected or contaminated tissue

29
Q

What are the possible complications of acute osteomyelitis?

A 
Septicaemia
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
30
Q

What can cause chronic osteomyelitis?

A

Can follow acute or start de novo

31
Q

What are the common causative organisms of chronic osteomyelitis?

A

Mixed infection

Staph aureus, e. coli, strep pyogenes, proteus species

32
Q

What is the pathology of chronic osteomyelitis?

A

Cavities
Dead bone
New bone formation
Chronic inflammation

33
Q

Wha is the treatment of chronic osteomyelitis?

A 
Long term antibiotics- local or systemic
Eradication surgery
Treat soft tissue problems
Deformity correction
Massive reconstruction
Amputation
34
Q

What are the possible complications of chronic osteomyelitis?

A 
Chronically discharging sinus and flare ups
Ongoing infection
Pathological fracture
Growth disturbance and deformities
Squamous cell carcinomas
35
Q

What are the routes of infection of acute septic arthritis?

A

Haematogenous
Eruption f bone abscess
Directly invasive- penetrating wound, intra-articular injury, arthroscopy
Infected joint replacement- most common

36
Q

What are the common bacterial causes of acute septic arthritis?

A

Staph aureus
H. influenzae,
Strep pyogenes
E. coli

37
Q

What is the pathology of acute septic arthritis?

A

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

38
Q

What are the possible outcomes of acute septic arthritis?

A

Recovery
Partial loss of articular cartilage and subsequent osteoarthritis
Fibrous or bone ankyloses

39
Q

What are the clinical features of acute septic arthritis in neonates?

A

Septicaemia
Irritability
Ill
Resistant to movement

40
Q

What are the clinical features of acute septic arthritis in children and adults?

A 
Acute pain in single large joint
Reluctant to move
Pyrexia
Tachycardia
Tenderness
41
Q

How is acute septic arthritis diagnosed?

A

FBC, WCC, ESR, CRP, blood cultures
Xray
US
Aspiration

42
Q

What is the differential for acute septic arthritis?

A 
Acute osteomyelitis
Trauma
Irritable joint
Haemophilia
Rheumatic fever
Gout
GAucher's disease
43
Q

What is the treatment of acute septic arthritis?

A

Supportive
Antibiotics- 3-4 weeks
Surgical drainage and lavage- in emergency setting

44
Q

What are the classifications of TB?

A

Extra-articular
Intraarticular
Vertebral body

45
Q

What is the pathology of TB?

A

Primary complex- often in lung or gut
Secondary spread
TB granuloma

46
Q

What are the clinical features of joint TB?

A 
Insidious onset and general ill health
Contact with TB
Pain, esp at night
Swelling
Weight loss
Pow grade pyrexia
Joint swelling
Decreased range of movement
Ankylosis
Deformity
Marked thickening of synovial
Marked muscle wasting
Periarticular osteoporosis
47
Q

What are the clinical features of spinal TB?

A

Little pain
Vertebral body collapse
Abscess or kyphosis

48
Q

What investigations ae done for joint TB?

A 
FBC, ESR
Mantoux test
Sputum/urine culture
Xray
Joint aspiration and biopsy
49
Q

What is the differential for joint TB?

A

Transient synovitis
Monoarticular arthritis
Pyogenic arthritis
Tumour

50
Q

What is the treatment of TB?

A

6 months rifampicin and isoniazid
2 months ethambutol and pyramidazole
Resp and splintage
Operative drainage

MSK AM (37 decks)

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