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MSK > Infections in Bone and Joints > Flashcards

Infections in Bone and Joints Flashcards

1
Q

What is osteomyelitis?

A

Bone infection

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2
Q

What is septic arthritis?

A

Joint infection

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3
Q

What are the types of osteomyelitis?

A

Acute
Chronic
Specific (TB)
Non-specific

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4
Q

What is acute osteomyelitis?

A

Mostly in young males
History of trauma

Associated with diabetes, immune compromise, long term steroid treatment and sickle cell

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5
Q

Where is the source of infection in acute osteomyelitis?

A

Haem spread

Local spread from contiguous site of infection (trauma, surgery or joint replacement)

Secondary to vascular insufficiency

Infants = infected umbilical cord
Children = boils, tonsilitis and skin abrasions
Adults = UTI or arterial line
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6
Q

What is the organisms in acute osteomyelitis?

A 
Infants = S. aureus, B strep and E. coli
Children = S. aureus, pyogenes and influenzae
Adults = S. aureus

Also salmonella and candida can cause

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7
Q

What is the pathology of acute osteomyelitis?

A

Metaphysis and spreads (femur, tibia, humerus, hip and elbow)

Inflammation, suppuration, release of pressure, necrosis, new bone formation and resolution (or not)

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8
Q

What are the clinical features of acute osteomyelitis?

A

May be minimal or very ill

  • Drowsy / irritable
  • Tenderness and swelling
  • Decreased movement
  • Commonest around knee
Children = not moving, fever, tachy, malaise and toxaemia
Adult = primary = in spine, backache, history of UTI
Secondary = more common after fracture or surgery
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9
Q

How to diagnose acute osteomyelitis

A 
History and exam
FBC + WBC
ESR and CRP
3 x Blood cultures
U+E's 
X-ray and USS
Isotope bone scan
Aspiration
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10
Q

Acute osteomyelitis DD

A

Soft tissue infection (cellulitis, nec fasc, gangrene TSS)
Septic arthritis
Acute inflammatory arthritis
Trauma
Transient synovitis
Rare = sickle, rheumatic fever and haemophilia

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11
Q

Radiographs in acute osteomyelitis

A

Early = minimal changes
Late osteonecrosis = sequestrum
Late periosteal new bone = involucrum

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12
Q

Acute osteomyelitis microbiological diagnosis

A

Blood cultures (in osteo and septic arthritis)
Bone biopsy
Tissue swabs from 5 sites

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13
Q

Acute osteomyelitis treatments

A 
Supportive - pain and dehydration
Rest and splintage
Antibiotics (fluclox and benpen) - depends on spectrum and penetration to bone
Surgery 
-Abscess drainage
-Debridement
-Joint replacement
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14
Q

What are the complications of acute osteomyelitis?

A 
Septicemia and death
Met infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
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15
Q

How does chronic osteomyelitis stary

A

Following acute
Following operation or acute fracture
In immunosuppressed, diabetic, elderly, IVDU
Repeated breakdown of healed wounds

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16
Q

What is the organism in chronic osteomyelitis

A

Often mixed

Mostly S. aureus, E. coli, S. pyogenes and proteus

17
Q

Pathology of chronic osteomyelitis

A

Cavities
Dead bone
Involucrum

18
Q

Complications of chronic osteomyelitis

A 
Discharging sinus and flare ups
Ongoing infection
Pathological fractures
Growth disturbances and deformities
Squamous cell carcinoma
19
Q

Treatment for chronic osteomyelitis

A 
Long term AB's
Eradicate bone infection
Soft tissue problems
Correct deformities 
Amputation?
20
Q

What is the route of infection in acute septric arthritis?

A 
Haematogenous
Eruption of bone abscess
Direct invasion
-Penetrating wound
-Intra-articular injury
-Artheroscopy
21
Q

What organisms can cause acute septic arthritis?

A

S. aureus
H. influenzae
S. pyogenes
E. coli

22
Q

What is the pathology of septic arthritis?

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked
Complete destruction of the articular cartilage

23
Q

What is the sequale of acute septic arthritis?

A

Complete recovery or
Partial loss of function and subsequent OA or
Fibrous / bony ankylosis

24
Q

What is the neonate presentation of septicaemia?

A

Irrirability
Resistant to movement
Ill

25
Q

What is the presentation of acute septic arthritis in children and adults?

A

Acute pain in a single large joint

  • Reluctant to move
  • Increased temp
  • Increased tenderness
  • Superficial joint
26
Q

What are the investigations for acute septic arthritis?

A

FBC, WVC, ESR, CRP and blood cultures
X-ray and USS
Aspiration

27
Q

What is the most common cause of acute septic arthritis in adults?

A

Infected joint replacement

28
Q

DD of acute septic artheritis

A 
OA
Trauma
Irritable joint
Haemophilia
Rheumatic fever
Gout
Gaucher's disease
29
Q

What is the treatment for acute septic artheritis?

A

Supportive measures
AB’s
Surgical drainage and lavage
Infected joint replacement

30
Q

What is the classification of TB osteomyelitis?

A

Extra-articular
Intra-articular
Vertebral body

Multiple lesions in 1/3 of patients

31
Q

What are the clinical features of TB osteomyelitis?

A 
Insidious onset and ill health
Contact with TB
Pain, swelling and weight loss
Pyrexia
Joint swelling and decreased ROM
Ankylosis and deformity
32
Q

What is the pathology of TB osteomyelitis?

A

Primary complex
Secondary spread
TB granuloma

33
Q

What happens in TB osteomyelitis of the spine?

A

Little pain

Present with abscess or kyphosis

34
Q

How do you diagnose TB osteomyelitis?

A 
History
Single joint involved
Thickening of he synovium
Marked muscle wasting
Periarticular osteoperosis
35
Q

What are the investigations for TB osteomyelitis?

A 
FBC and ESR
Mantoux
Sputum and urine culture
X-ray
Joint aspiration and biospy
36
Q

What are the DD for TB osteomyelitis?

A 
Transient synovitis
Monoarticular RA
Haemorrhagic arthritis
Pyogenic arthritis
Tumour
37
Q

What is the treatment for TB osteomyelitis?

A

Rifampicin, isoniazid and ethambutol (8W)

Rest and splintage

MSK (21 decks)

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