Infections and vascular diseases of bone Flashcards
List the infections of bone?
- suppurative osteomyelitis
- Brodies’ abscess
- TB of bone
List the diseases of vascular influences?
- osteochondrosis = epiphyseal
* osteonecrosis = aseptic necrosis = avascular necrosis
What is suppurative osteomyelitis?
- infection of bone marrow
- pus
- except for TB bacteria
- localized or generalized
- acute or chronic
What is the pathology of suppurative osteomyelitis?
- 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
sequestrum
dead bone
involucum
collar of new periosteal bone
What are the clinical features of suppurative osteomyelitis?
Kids: acute tenderness, swelling, pyrexia
- adults more chronic
- extremities
What is Mainliner’s syndrome?
- intravenous drug users predisposed to suppurative osteomyelitis
- S joints: spine, SI, pubic symphysis, SC
What are the complications of suppurative osteomyelitis?
- septicaemia or pyaemia
- extension to adjacent joint (septic arthritis)
- retardation of growth
- pathological fracture
- Marjolin’s ulcer
What is Marjolin’s ulcer?
malignant degeneration of cells lining cloaca
What investigations can we do for suppurative osteomyelitis?
- blood culture positive
* ESR increased
What is Brodie’s abscess?
- form of chronic suppurative osteomyelitis
- insidious
- deep boring pain
What is chronic bone abscess?
another name for Brodie’s abscess
What are the aetiologies of bone TB?
a) hematogenous spread from lungs
b) direct extension from adjacent focus
c) immunodeficient patients
What are the common sites for bone TB?
- vertebral bodies
- adjacent joints
- long bone
- hand or foot
Vetebral TB
Tubercular Arthritis
What is the pathology of bone TB?
- insidious and chronic onset and progression
- bone destroyed ad replaced by granulation tissue
- TB abscess
What is vertebral TB?
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
What is Tubercular Arthritis? (pathology and features)
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
What are the aetiologies of epiphyseal disorders?
• unknown, but 3 groups
Osteonecrosis
Trauma
Normal growth variants
What are predisposing factors to osteonecrosis?
- genetic predisposition
- environmental factors
- thrombotic predisposition
- acute or repeated trauma
- embolism
- copper deficiency
- infection
- mechanical factors
What is the pathology of epiphyseal disorders?
• Avascular necrosis in the ossification centres
• degeneration of epiphyseal osseous nucleus due to:
-interference with blood supply
-failure of bony centrum to enlarge
List the epiphyseal disorders
- Legg-Calve-Perthes
- Osgood-schlatter
- Kienboch’s
- Freiberg’s
- Scheuermann’s
- Kohler’s
- Osteochondritis
- Sinding-Larsen-Johanson
- Sever’s
Legg-Calve-Perthes
- femoral capital epiphysis
- osteonecrosis
- male 4-10yrs
- short Hx of painful limp
- referred knee pain
Osgood-schlatter
- tibial tubercle
- trauma
- males 11-15
- pain & swelling
- Hx of repetitive knee flex/ext.
Kienboch’s
- lunate
- trauma + osteonecrosis
- males 20-40yrs
- worsening pain, disability
- Hx of heavy tool operation (vibration and force)
Freiberg’s
- metatarsal head
- trauma + osteonecrosis
- females 15-18yrs
- pain & swelling with activity
Scheuermann’s
- vertebral endplate epiphysis
- trauma
- males 15-17
- pain & fatigue, hyperkyphosis
Kohler’s
- navicular
- trauma + ON or growth variant
- 6-9yrs
- boys
- pain and swelling
Osteochondritis dissecans
- distal femoral condyle
- trauma
- males 11-20yrs
- pain, swelling, locking
Sinding-Larsen-Johanson
- secondary patella centre
- trauma
- same as stood shlatter
Sever’s
- calcaneus
- growth variant
- boys > girl
- 9-11yrs
- pain with activity
What investigations do we do for epiphyseal disorders?
X-ray:
• lost contour
• increased density
• fragmentation
What is aseptic necrosis?
another name for osteonecrosis
What is avascular necrosis?
another name for osteonecrosis
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
What is a common site of osteonecrosis?
head of femur
head of humerus
scaphoid
What investigations can we do for osteonecrosis?
- x-rays (maybe not apparent for weeks)
* MRI -most sensitive
In what situation would an epiphyseal fracture be likely to occur?
extreme forces in children
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
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
What are common sites to get suppurative osteomyelitis?
S joints:
- spine
- SI
- pubic symphysis
- SC
