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Medical Sciences B > Infections and vascular diseases of bone > Flashcards

Infections and vascular diseases of bone Flashcards

1
Q

List the infections of bone?

A
  • suppurative osteomyelitis
  • Brodies’ abscess
  • TB of bone
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2
Q

List the diseases of vascular influences?

A
  • osteochondrosis = epiphyseal

* osteonecrosis = aseptic necrosis = avascular necrosis

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3
Q

What is suppurative osteomyelitis?

A
  • infection of bone marrow
  • pus
  • except for TB bacteria
  • localized or generalized
  • acute or chronic
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4
Q

What is the pathology of suppurative osteomyelitis?

A
  • Organism seeds into medullary tissue -> vascular and cellular response -> swelling -> compression and infarction of surrounding tissue -> further inflammation -> progression of infection -> dead bone -> collar of new periosteal bone
  • drainage tract can form to bone surface
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5
Q

sequestrum

A

dead bone

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6
Q

involucum

A

collar of new periosteal bone

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7
Q

What are the clinical features of suppurative osteomyelitis?

A

Kids: acute tenderness, swelling, pyrexia

  • adults more chronic
  • extremities
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8
Q

What is Mainliner’s syndrome?

A
  • intravenous drug users predisposed to suppurative osteomyelitis
  • S joints: spine, SI, pubic symphysis, SC
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9
Q

What are the complications of suppurative osteomyelitis?

A
  • septicaemia or pyaemia
  • extension to adjacent joint (septic arthritis)
  • retardation of growth
  • pathological fracture
  • Marjolin’s ulcer
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10
Q

What is Marjolin’s ulcer?

A

malignant degeneration of cells lining cloaca

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11
Q

What investigations can we do for suppurative osteomyelitis?

A
  • blood culture positive

* ESR increased

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12
Q

What is Brodie’s abscess?

A
  • form of chronic suppurative osteomyelitis
  • insidious
  • deep boring pain
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13
Q

What is chronic bone abscess?

A

another name for Brodie’s abscess

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14
Q

What are the aetiologies of bone TB?

A

a) hematogenous spread from lungs
b) direct extension from adjacent focus
c) immunodeficient patients

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15
Q

What are the common sites for bone TB?

A
  • vertebral bodies
  • adjacent joints
  • long bone
  • hand or foot

Vetebral TB
Tubercular Arthritis

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16
Q

What is the pathology of bone TB?

A
  • insidious and chronic onset and progression
  • bone destroyed ad replaced by granulation tissue
  • TB abscess
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17
Q

What is vertebral TB?

A

Pathology:
• anterior subchondral vertebral endplate, blocks conducting arteriole/venule
• caseous necrosis of surrounding tissue
• infection into disc
• vertebral collapse
• tracks down to next vertebrae spinal canal

Features:
• initially pain and stiffness
• severe pain with vertebral collapse
• later fever, night sweats, ill health

18
Q

What is Tubercular Arthritis? (pathology and features)

A

Pathology: metaphysal portion of bone with secondary joint involvement

  • tenderness, swelling, stiffness, heat at joint
  • atrophy, deformity
  • lesion elsewhere
  • Dx made with history, clinical features, x-ray findings
19
Q

What are the aetiologies of epiphyseal disorders?

A

• unknown, but 3 groups

Osteonecrosis
Trauma
Normal growth variants

20
Q

What are predisposing factors to osteonecrosis?

A
  • genetic predisposition
  • environmental factors
  • thrombotic predisposition
  • acute or repeated trauma
  • embolism
  • copper deficiency
  • infection
  • mechanical factors
21
Q

What is the pathology of epiphyseal disorders?

A

• Avascular necrosis in the ossification centres
• degeneration of epiphyseal osseous nucleus due to:
-interference with blood supply
-failure of bony centrum to enlarge

22
Q

List the epiphyseal disorders

A
  • Legg-Calve-Perthes
  • Osgood-schlatter
  • Kienboch’s
  • Freiberg’s
  • Scheuermann’s
  • Kohler’s
  • Osteochondritis
  • Sinding-Larsen-Johanson
  • Sever’s
23
Q

Legg-Calve-Perthes

A
  • femoral capital epiphysis
  • osteonecrosis
  • male 4-10yrs
  • short Hx of painful limp
  • referred knee pain
24
Q

Osgood-schlatter

A
  • tibial tubercle
  • trauma
  • males 11-15
  • pain & swelling
  • Hx of repetitive knee flex/ext.
25
Kienboch's
* lunate * trauma + osteonecrosis * males 20-40yrs * worsening pain, disability * Hx of heavy tool operation (vibration and force)
26
Freiberg's
* metatarsal head * trauma + osteonecrosis * females 15-18yrs * pain & swelling with activity
27
Scheuermann's
* vertebral endplate epiphysis * trauma * males 15-17 * pain & fatigue, hyperkyphosis
28
Kohler's
* navicular * trauma + ON or growth variant * 6-9yrs * boys * pain and swelling
29
Osteochondritis dissecans
* distal femoral condyle * trauma * males 11-20yrs * pain, swelling, locking
30
Sinding-Larsen-Johanson
* secondary patella centre * trauma * same as stood shlatter
31
Sever's
* calcaneus * growth variant * boys > girl * 9-11yrs * pain with activity
32
What investigations do we do for epiphyseal disorders?
X-ray: • lost contour • increased density • fragmentation
33
What is aseptic necrosis?
another name for osteonecrosis
34
What is avascular necrosis?
another name for osteonecrosis
35
What is osteonecrosis? aetiology? clinical features?
* death of localized portion of bone, and marrow * idiopathic or secondary * trauma, repetitive * high dose corticosteroids * radiotherapy * decompression sickness * sickle cell disease * absence of infection * referred pain, swelling, lost ROM, muscle atrophy * maybe asymptomatic
36
What is a common site of osteonecrosis?
head of femur head of humerus scaphoid
37
What investigations can we do for osteonecrosis?
* x-rays (maybe not apparent for weeks) | * MRI -most sensitive
38
In what situation would an epiphyseal fracture be likely to occur?
extreme forces in children
39
What are the routes of infection for acute suppurative osteomyelitis?
1) Haematogenous: via organisms that have gained access to the blood stream 2) Contiguous: via direct spread from local infection (eg. cellulitis) 3) Penetrating trauma: via open fracture or surgical operations in which organisms gain entry directly
40
List and describe 3 types of osteochondroses occurring in the lower limb
1) Osgood shlatters: tibial tuberosity -trauma from repeated flex/ext of knee 2) Kholers: Navicular -trauma or osteonecrosis and trauma 3) Sinding-Larsen-Johanson: -secondary patella centre, trauma same as os good shlatter
41
What are common sites to get suppurative osteomyelitis?
S joints: - spine - SI - pubic symphysis - SC

Medical Sciences B (23 decks)

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