infection in bone and joints Flashcards
osteomyelitis
acute
chronic
specific
non specific (most common)
source of infection
haematogenous spread trauma, bone surgery, joint replacement secondary to vascular insufficiency infants: infected umbilical cord children: boils, tonsilitis, adults: UTI, arterial line
organisms
infants- staph aures, group B streptococci, Ecoli
Older children: staph aureus, strep pyongenes, haemophilus influenzae
adults: staph aureus, coagulase negative staphylococci, psedomonoas aeroginosa
special cases
diabetic foot and pressure sores- mixed infection
vertebral osteomyelitis- S.aureus, TB
Sickle cell disease- Salmonella
STD- gonococcus
pathology
vascular stasis acute inflammation- increased pressure suppuration release of pressure necrosis of bone new bone formation
clinical features
severe pain
reluctant to move
may be tender fever
malaise (fatigue, nausea)
differential diagnosis
acute septic arthritis
trauma
acute inflammatory arthritis
transient synovitis
diagnosis
ultrasound
aspiration
isotope bone scan
labelled white cell scan
radiograph of osteomyelitis
normal in first 10 days later shows increasing metaphyseal destruction
osteonecrosis
sequestrum
periosteal new bone
involucrum
treatment
supportive
rest& splintage
antibiotics
complications
septicemia, death
metastatic infection
pathological fracture
septic arthritis
subacute osteomyelitis
long history
differential diagnosis
tumour
TB
Brodie’s abscess
Subacute osteomyelitis
DDx Ewing’s sarcoma
chronic osteomyelitis
often mixed infection
usually same organisms each flare up
staph aureus, ecoli, strep pyogenes, proteus
treatment
long term antibiotics
local-gentamicin
systemic
complications
chronicallly discharging sinus+ flare ups
ongoing metatatic infection
pathological fracture
acute septic arthritis
pathology
acute synovitis with purulent joint effusion
complete destruction of articular cartilage
treatment
surgical drainage & lavage
tuberculosis clinical features
insidious onset contact with TB pain, swelling, loss of weight low grade pyrexia joint swelling decrease ROM ankylosis deformity
TB spinal
little pain
present with abscess or kyphosis
diagnosis
long history involvement on single joint marked thickening of synovium marked muscle wasting periarticular osteoporosis Ddx transient synovitis
treatment
rifampicin
isoniazid
ethambutol 8 weeks
rifampicin and isoniazid 6 to 12 months
