Infection SOM and NSOM and Miscellaneous Flashcards
Suppurative Osteomyelitis (SOM) male to female ratio
3:1
Suppurative Osteomyelitis Peak Age range ,MC affected Bone, and what bacteria is responsible (generally)
2-12 y.o.a
Femur
Staph Aureus
Suppurative Osteomyelitis In drug addicts this bacteria is most common and likes the “S” joints
Psuedomonas
Suppurative Osteomyelitis What is the most common route of spread
Hematogenous
What are the other three routes of spread of SOM other than the most common?
- Contiguous Source (direct from another site of infection)
- Direct Implantation (puncture wounds, penetrating injuries, open fx’s)
- Post-operative
The following SOM clinical features are indicative of Infantile, Childhood, or Adult:
Commonly multi-focal
Pain and swelling in region of infection
Infant unwilling to move affected bone
Streptcoccus group B common, especially in humerus
Infantile
The following SOM clinical features are indicative of Infantile, Childhood, or Adult:
Males most commonly affected
Staph. Aureus most common organism
Acute onset of symptoms
Local signs of inflammation, systemic signs of infection
Childhood
The following SOM clinical features are indicative of Infantile, Childhood, or Adult:
Has a more insidious onset
Local signs of inflammation, system signs of infection
Adult
Pathophysiology (Predilection) in SOM depends on _________________ anatomy and age.
Vascular
In Infantile predilection (SOM)
- seen in 0-1 y.o.a.
- Vessels ___________ the open growth plate
- The e ________ or m________ can be affected as well
as the joint
Perforate
epiphysis or metaphysis
In Childhood predilection (SOM)
- Metaphysis is MC site of origin
- Vessels do not perforate growth plate
- seen in __ to ___ years of age and is most MC for this age
group
1-16 years of age
In ADULT predilection (SOM)
Over 16 years of age (age depends on site of involvement)
- Vessels ____ penetrate the closed growth plate
- Epiphyseal region and metaphysis can be involved, as well as the joint
Do penetrate the growth plate!!!!!
If left untreated, describe the pathophysiological progression of the organism(s)…
Deposit where? Enter via what? breaks thru and the subperiosteal region to spread underneath what?
All that leads to a loss of ________ supply and eventually _________.
Deposit –> Medullary bone
Enter the cortex via the Haversian and Volkman’s Canals
break through cortex and subperiosteal region to spreads underneath the periosteum.
Leads to loss of blood supply and eventually necrosis
Definition: Infection of disc space, related to vertebral body osteomyelitis usually from hematogenous spread.
Discitis
Radiographic findings of DISCITIS
- Focal endplate destruction which progresses to
extensive
destruction and _________collapse - Disc space ________
- Will typically spare the posterior elements.
During healing - increased vertebral body sclerosis and can develop _________
Vertebral
Narrowing
Ankylosis
Necrotic bone separated from viable bone by granulation tissue is called
Sequestrum
Living bone that forms around necrotic bone and attempts to wall off infection is called
Involucrum
______ is an opening in involucrum that allows the infection region to decompress
Cloaca
MRI Findings of Discitis
- Bone Marrow Edema
- Early endplate destruction, best seen on ___images
- Changes BEGIN at endplate and EXTEND into _____
- On T2 images paraspinal edema and _____ with
increased focal fluid collection signal is visible - Contrast enhancement within disc space may be subtle
- Can see peripheral enhancement due to infection within
psoas, paraspinal soft tissue, or epidural space - MRI is most _______ and specific imaging test
- Bone scan has ________ sensitivity compared to
detection of osteomyelitis at other sites in body
T1 Vertebral bodies Phlegmon Sensitive Diminished
Radiological Changes in Extremities w/ SOM
Soft Tissue Changes
- Occur within __ days of infection
- Localized swelling and fat plane displacement
- _______ of fat/muscle interface
- Disruption of normal contour of skin, if SEVERE
- May see gas with certain organisms
3 days
Blurring
Radiological Changes in Extremities w/ SOM
Osseous Changes
- ___ day Latent period on X-ray
- Permeative or ___ eaten pattern of bone destruction
- ______ or Laminated periosteal reaction
- Sequestrum, Involcrum and cloaca present
- Spinal changes are primarily ______
10 day latent period
Moth-eaten
Solid Laminated Periosteal Rxn
Articular
Describe treatment for SOM in the Extremities? What is key?
Early diagnosis is key to successful treatment.
Antibiotic therapy is the initial treatment of choice, often intravenous.
What are the 5(possible) Complications of SOM in the extremities
People Give Bad Advice from Medical Doctors So it eventually can lead to death
- Acronym with the Capital letters only*
This is a joke and not me true feelings towards other healthcare professionals. LMAO
- Pathological fx’s
- Growth disturbances
- Bony ankylosis of joints
- Malignant degeneration to squamous cell carcinoma
- Septicemia (can eventually lead to death)
A sharply outlined focus of burned out infection, which can be sterile or contain residual staph is known as what type of abscess
- 1cm in diameter and a variable zone of reactive
necrosis - Oval in shape “seripiginous lucency”
- Likes the distal _____ and K____
Brodie’s Abscess
Distal Tibia and Knee
Differential Diagnosis for Brodie’s Abscess
1.
2.
O.O.
Osetoblastoma
Treatment for Brodie’s
Surgical Decompression and Curettage
Non-Supprative Osteomyelitis (NSOM) aka “TB”
Most skeletal changes are _______ in nature
articular
What are the 4 Unusal Ossesous Presentations in TB C TD P W
Cystic TB
Tuberculous Dactylitis
Pott’s Puffy Tumor
Weaver’s Bottom
What TB presents with round to oval lucent lesions in the appendicular skeleton. Can mimic polyostotic tumor-like conditions.
Cystic TB
What TB of the tubular bones of the hands/feet (spina ventosa)
Tuberculous Dactylitis:
Dactyl means
pertaining to fingers or toes
TB of the skull with cold abscess of scalp
Pott’s Puffy Tumor
TB of the subgluteal bursa that extends into the ischial tuberosity
Weaver’s Bottom
Syphilitic Osteomyelitis: CONGENITAL
o Transmitted from ______ to _____ through the _____
mother to child
placenta
Syphilitic Osteomyelitis Radiographic Features (3)
Phase 1 – Metaphysitis Present from \_\_\_\_\_\_\_ Lucent metaphyseal bands, medial tibial erosions MC at k\_\_\_\_\_,s\_\_\_\_\_, and w\_\_\_\_\_\_ Usually resolve spontaneously
Birth
Knee, Shoulder and Wrist
Syphilitic Osteomyelitis: ACQUIRED
o Changes due to tertiary syphilis
o Extensive p_____ is MC finding, often affecting multiple bones
o Can see gummata, saber shin deformity, extensive destruction of both tables of the skull
periostitis
Misc. Forms: COCCIDIOIDOMYCOSIS
o Endemic in the Southwestern US
o Skeletal involvement usually _____to ______disease
o Seen in ____% of disseminated form – can be fatal
o Primary x-ray finding is lucent destruction, with predisposition to affect ____________
secondary to respiratory
20%
bony prominences
Misc. Forms: ACTINOMYCOSIS
o Osseous involvement usually due to direct extension from
a soft ________ Infection
o Likes the ______ (MC), spine, ribs, and pelvis
o In the mandible, usually follows tooth extraction or
infection
o Lytic, destructive process in the flat bones. In the spine,
bodies are usually destroyed, sparing __________.
tissue
mandible
the discs
Misc. Forms: LEPROSY
o Characterized by atrophic destruction of the bones of the
____and ______
o May see nerve calcification (rare)
hand and feet
