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MSK > Infection in Bone and Joints - Pt 1 > Flashcards

Infection in Bone and Joints - Pt 1 Flashcards

1
Q

What is osteomyelitis?

A

Infection of the bone
Can be acute or chronic and specific (TB) or non-specific (most common)

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2
Q

What are some features of acute osteomyelitis?

A

Mostly children
More boys than girls
History of trauma
Adults - other disease - DM, rheumatoid arthritis, immunocompromised, long term steroid treatment and sickle cell

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3
Q

What is the source of infection for acute osteomyelitis?

A

Haematogenous spread - children and elderly
Local spread from contiguous site of infection - trauma, bone surgery and joint replacement
Secondary to vascular insufficiency

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4
Q

What is the main source of infection in infants for acute osteomyelitis?

A

Infected umbilical cord

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5
Q

What is the main source of infection in children for acute osteomyelitis?

A

Boils, tonsillitis, and skin abrasions

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6
Q

What is the main source of infection in adults for acute osteomyelitis?

A

UTI and arterial line

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7
Q

What organisms are present in acute osteomyelitis for infants and older children?

A

Infants - staph aureus, group B streptococci and E.coli
Older children - staph aureus, strep pyogenes, and haemophilus influenza

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8
Q

What organisms are present in acute osteomyelitis in adults?

A

Staph aureus (main), mycobacterium tuberculosis, pseudomonas aeruginosa, coagulase negative staphylococci and Propionibacterium spp

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9
Q

What other organisms can be present in acute osteomyelitis?

A

Diabetic foot and pressure sores - mixed including anaerobes
Vertebral osteomyelitis - s. aureus and TB
Sickle cell disease - salmonella spp.
Brucella, mycobacterium marinum, proteus mirabilis and candida

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10
Q

Where is common sites for acute osteomyelitis?

A

Long bones - metaphysis - distal femur, proximal tibia and proximal humerus
Joints with intra-articular metaphysis - hip and elbow

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11
Q

Describe the pathology of acute osteomyelitis

A

Starts at metaphysis - vascular stasis - acute inflammation - increased pressure - suppuration - release of pressure - necrosis of bone, new bone formation, and resolution or not

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12
Q

What are the clinical features of acute osteomyelitis in infants?

A

May be minimal signs or may be very ill
Failure to thrive
Drowsy or irritable
Metaphyseal tenderness and swelling
Decreased ROM
Positional change
Commonest around knee and often multiple sites

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13
Q

What are the clinical features of acute osteomyelitis in children?

A

Severe pain
Reluctant to move - neighbouring joints held fixed and not weight bearing
Fever (swinging pyrexia) and tachycardia
Malaise
Toxaemia

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14
Q

What are the clinical features of acute osteomyelitis in adults?

A

Primary OM seen commonly in thoracolumbar spine
Backache
History of UTI or urological procedure
Elderly, diabetic and immunocompromised
Secondary OM is more common

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15
Q

What bloods are included in diagnosis of acute osteomyelitis?

A

FBC and Diff WBC
ESR and CRP
Blood cultures x 3
U+Es if ill and dehydrated

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16
Q

What investigations are done for diagnosis of acute osteomyelitis?

A

X-ray, US, aspiration, isotope bone scan, labelled white cell scan and MRI

17
Q

Describe radiographs and acute osteomyelitis

A

Early radiographs minimal changes
10-20 days early periosteal changes
Medullary changes - lytic areas
Late osteonecrosis - sequestrum
Late periosteal new bone - involucrum

18
Q

What scans are used for acute osteomyelitis?

A

Techneticum-99m labelled diphosphonate
Gallium 67 citrate delayed imaging
Indium-111 labelled WBC scan
MRI

19
Q

What are the differential diagnosis for acute osteomyelitis?

A

Acute septic arthritis, trauma, acute inflammatory arthritis, transient synovitis and rare - sickle cell crisis, Gaucher’s disease, rheumatoid fever and haemophilia
Soft tissue infection

20
Q

What soft tissue infections can be a differential diagnosis for acute osteomyeltis?

A

Cellulitis, erysipelas, necrotising fasciitis, gas gangrene and toxic shock syndrome

21
Q

What is the microbiological diagnosis for acute osteomyelitis?

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 can be misleading

22
Q

What is the treatment for acute osteomyelitis?

A

Supportive treatment for pain and dehydration - general care and analgesia
Rest and splints
Antibiotics - IV then oral switch. Empirical (Fluclox and BenzylPen) while waiting

23
Q

What are reasons for antibiotic failure in acute osteomyelitis?

A

Drug resistance, bacterial persistence, poor host defences, poor drug absorption, drug inactivation by host flora and poor tissue penetration

24
Q

What is the indication for surgery in acute osteomyelitis?

A

Aspiration of pus for diagnosis and culture
Abscess drainage
Debridement of dead/ infected/ contaminated tissue
Refractory to non-operative Rx > 24-48hrs

25
Q

What are the complications of acute osteomyelitis?

A

Metastatic infection, pathological fracture, septic arthritis, septicaemia death, altered bone growth and chronic osteomyelitis

26
Q

Describe chronic osteomyelitis

A

May follow acute osteomyelitis
May start de novo - following operation, immunocompromised, elderly, drug abusers…
Repeated breakdown of healed wounds

27
Q

What is the organisms for chronic osteomyelitis?

A

Often mixed infection
usually same organism each flare up
Mostly Staph. aureus, E.coli, strep pyogenes and proteus

28
Q

Describe the pathology of chronic osteomyelitis

A

Cavities, poss. sinus
Dead bone
Involucrum
Histological picture is one of chronic inflammation

29
Q

What is the treatment for chronic osteomyelitis?

A

Long term antibiotics
Eradicate bone infection surgically
Treat soft tissue problems
Possible deformity correction, massive reconstruction, and amputation

30
Q

What are the complications for chronic osteomyeltitis?

A

Chronically discharging sinus and flare ups
Ongoing infection
Pathological fracture
Growth disturbance and deformities
Squamous cell carcinoma

MSK (39 decks)

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