Infections and the Ortho Patient

Question 1

What bacteria commonly have a biofilm making them more resistant to abx?

Answer 1

pseudomonas

Question 2

Elevates within 2 days of infection and will continue to rise for next 3-5 after appropriate tx

Answer 2

ESR

Question 3

Elevates within 6hrs, peaks at 48hrs, returns to NL 1 wk after appropriate tx. Best indicator for monitoring tx

Answer 3

CRP

Question 4

Type of osteomyelitis transferred by the blood. More common in males and S. aureus is the most common pathogen

Answer 4

hematogenous

Question 5

TYpe of osteomyelitis caused by a prior infection. Subdivided by presence or absence of vascular insufficieny. S aureus is most common pathogen. Leads to necrosis and soft tissue damage

Answer 5

contiguous

Question 6

Most common site for hematogenous osteomyelitis

Answer 6

vertebrae

Question 7

How long should abx be continued to adequately treat osteomyelitis?

Answer 7

4-6 weeks

Question 8

What abx should be used as suppressive abx therapy when surgical tx isn’t an option?

Answer 8

rifampin w/fluoroquinolone or Bactrim for 6 mos

Question 9

Mainstay of treatment for osteomyelitis

Answer 9

surgical debridement

Question 10

should be should be thought of as soft tissue injuries that happen to have a broken bone. This is especially true of high-energy injuries

Answer 10

open fractures

Question 11

Most common joint that gets septic arthritis in adults

Answer 11

knee

Question 12

Gold standard for diagnosis of septic arthritis

Answer 12

aspiration

Question 13

Treatment of septic arthritis

Answer 13

arthrotomy and abx

Question 14

Why does pediatric osteomyelitis often occur in the metaphysis?

Answer 14

large vascularity and low flow rate

Question 15

Treatment of chronic osteomyelitis in kids

Answer 15

I&D with abx 6-12 months

Question 16

Flexed, Abducted, and External Rotation in hip. Severe pain with PROM and rotation

Answer 16

septic arthritis

Question 17

Occur by: Direct contact during the surgery. After the surgery (draining incision). Hematogenous inoculation

Answer 17

periprosthetic infections

Question 18

First indicator of periprosthetic infection

Answer 18

pain not changed by activity levels

Question 19

Normal white blood cell count from aspiration of prosthetic joint

Answer 19

1,700 w/ <65% leukocytes

Question 20

Used for short term periprosthetic infections. removal of all easily removed components, mechanical scrubbing of retained components and replacement of removed components

Answer 20

single stage revision

Question 21

Used for long term periprosthetic infections. removal of all components. Placement of an abx cement spacer. Abx for 6 weeks with abx holiday and evaluation of blood work. If “normal” then return to surgery for revision arthroplasty

Answer 21

two stage revision