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Orthopaedics > Infections > Flashcards

Infections Flashcards

1
Q

Which part of skeleton does TB most commonly affect?

A

Spine

Then hip

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2
Q

What is Pott’s disease

A 
TB spondylitis (spine) - complication
Paraplegia
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3
Q

What is bac load of spine TB

A

Low-paucibacillary

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4
Q

How does tb spine spread? (4)

A

Along ant long ligament
Post into spinal cord → cord compression and paralysis
Down psoas muscle to groin
Posterior: triangle of petit (inf lumbar triangle)

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5
Q

4 symptoms spinal TB

A
  1. Slow growing bac-prolonged constitutional symptoms
  2. Malnourished
  3. Severe pain late sign - ass W/ bone collapse
  4. Neuro symps eg lower limb weak and numb- Potts paraplegia
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6
Q

2 possible findings on Clin examination of back in spinal TB

A

Gibbus. (prominent spinous process)

Psoas abscess

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7
Q

Which part of spine most commonly affected by tb

A

Thoracic

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8
Q

Xr features spinal TB early and late (9)

A

Early:
• local osteoporosis of 2 adjacent vertebrae
• Narrow disc spaces
• fuzziness of end plates

Late
• disc space destruction
• lucency and compression of adjacent vertebral bodies
• severe kyphosis (gibbus)
• paraspinal soft tissue shadows due to oedema, swelling or paravertebral abscess
• paraspinal abscess
. Sclerotic + lytic lesions

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9
Q

Microscopy stains available to diagnose TB (2)

A

Ziehl - Nielsen stain: acid fast bacilli

H&E stain: TB granuloma

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10
Q

Where does TB hip begin (3)

A

Superior rim acetabulum (early joint invasion)
Epiphysis
Greater trochanter

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11
Q

3 radiological signs of hip TB

A

Phemister triad: periarticular osteoporosis, femoral head and neck erosions, decreased joint space
Kissing sequestra: femoral and acetabular sides wedge shaped necrosis
“Wandering acetabulum”

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12
Q

What is a “fight bite” (3)

A

Attacker with finger in full flexion punches another penson in mouth with clenched fist.
Presents as pt fingers in extension
Superficial puncture wound
Much deeper into MPJ - “closing off”
Extremely dangerous palymicrobial infection!

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13
Q

If you see a fist wound, what should you suspect?

A

fight bite - human bite

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14
Q

What do kanavel’s 4 cardinal signs indicate?

A

Septic tenosynovitis

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15
Q

What are kanavel’s four cardinal signs

A

(Indic tenosynovitis of hand )

  1. Slight flexion finger
  2. Swelling
  3. Pinpoint tenderness over sheath
  4. Pain on passive extension
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16
Q

What is osteomyelitis

A

Bone infection involving medullary cavity with progressive inflammatory destruction, typically bacterial

17
Q

Etiology osteomyelitis? (2)

A
  • Most commonly S aureus. Also group B strep in neonates, kingElla kingae, pseudomonas in direct puncture wounds to foot…
  • mechanism of spread mostly hematogenous, also direct inoculation and contiguous focus
18
Q

Name 6 risk factors osteomyelitis

A
  • Diabetes mellitus , peripheral neuropathy, poor vascular supply
  • hemoglobinopathy, especially sickle cell disease
  • immune compromise, iv drug use, malnutrition
  • recent trauma / surgery
  • poor hygiene, male
  • children at risk !
19
Q

Clinical features (symptoms and exam) of osteomyelitis? (7)

A

Symptoms:
. pain with limp or refusal to bear weight
• may have fever

Examination
• erythema (rubor)
• tenderness (dolor)
•Edema (tumor)
• hot (calor)
• may have abscess or draining sinus tract
20
Q

Which investigations should be done for osteomyelitis? (5)

A
  • WBC count elevated, not very sensitive
  • ESR elevated, very sensitive for diagnosis
  • CRP increased, most sensitive to monitor treatment response
  • blood culture: only positive in 50% or less
  • aspirate culture/bone biopsy if really not sure - do surgical drainage if pus is aspirated
21
Q

Treatment acute osteomyelitis? (4)

A

Iv antibiotics 4-6 weeks, started empirically and adjusted after obtaining blood and aspirate cultures
. S aureus: first line flucloxacillin; second line ceftriaxone / clindamycin
. MRSA: first line vancomycin and rifampicin; second line linezolid or daptomycin

Surgery incision and drainage if abscess, significant involvement, chronic infection, failure to respond to antibiotics

22
Q

Treatment chronic osteomyelitis? (5)

A
  1. Surgical debridement
  2. Dead space management
  3. Bone stability: may need external fixation
  4. Antibiotics: local and systemic after cultures
  5. Soft tissue cover
23
Q

Name 5 complications osteomyelitis

A
  • DVT, especially older children and adults
  • meningitis
  • septic arthritis, especially neonates
  • growth disturbances and limb length discrepancy from growth plate involvement
  • pathologic fractures
24
Q

Septic arthritis etiology? (4)

A
  • Adults: S aureus mostly
  • prior joint replacement: coagulase negative staphylococcus
  • sexually active adults and newborns: neisseria gonorrhoea

• most common route = haematogenous

25
Q

Name 7 risk factors septic arthritis

A
  • Young and elderly >80
  • any pre-existing joint disease eg ra, oa, Uraemia
  • immune suppression: diabetes mellitus, alcoholism
  • hip or knee joint prosthesis
  • iv drug use
  • skin infection or ulcer
  • previous intra-articular corticosteroid injection
26
Q

Clinical features septic arthritis? (5)

A
  • rubor (redness)
  • dolor (pain) ! And Inability to weight bear , pseudoparalysis children
  • tumor (oedema)
  • Color (warmth)
  • fever in 60%

• paeds hip: leg held in flexion and external rotation, fullness palpable in loin and upper thigh(late sign),

If child can flex and extend joint, IT IS NOT SEPTIC ARTHRITIS!

27
Q

Name the kocher criteria

A

To differentiate between septic arthritis and transient tenosynovitis in child with painful hip. If present, give 1 point
• unable to weight bear
• pyrexia >38,5
• wcc >12 x10^9 cells/l
• ESR>40 mm/h
Score of 3 or more = 93% probability of septic arthritis

28
Q

Which investigations should be done if suspect septic arthritis? (6)

A

• Xray to rule out #, tumour, metabolic bone disease
• ESR (>40 mm/h)
• CRP
• WBC (>12 x10^9 cells/L)
• blood cultures
. Joint aspiration for gram stain, leukocyte count, microscopy and culture - best to do during arthrotomy, not aspiration
• listen for heart murmur (infective endocarditis)

29
Q

Treatment septic arthritis? (2)

A
  • Empirical antibiotics (cloxacillin) ASAP adjusted when culture comes back after /during arthroscopy
  • arthroscopy = definitive treatment for irrigation and debridement and drainage
30
Q

Name the 4 joints in order that are most commonly affected by septic arthritis

A
  • Hip
  • elbow
  • ankle
  • sternoclavicular joint
31
Q

Name 3 complications septic arthritis

A
  • Adults: secondary osteoarthritis, ankylosis (fused joint), contractures
  • Paediatrics destroy epiphysis: osteonecrosis and osteomyelitis!, (fixed flexion) deformities
32
Q

What is sequestrum?,

A 
a piece of dead bone tissue formed within a diseased or injured bone, typically in chronic osteomyelitis.
Appear sclerotic (white) on xr
33
Q

What is involucrum?

A

a complication of osteomyelitis - a thick sheath of periosteal new bone surrounding a sequestrum. To protect bone from breaking

34
Q

What is a cloaca?

A

a gap in the cortex of a bone affected by chronic osteomyelitis that allows the drainage of pus or other material from the bone into the adjacent tissues.

Orthopaedics (20 decks)

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