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Equine Medicine and Surgery > Lecture 19: Orthopedic Infection > Flashcards

Lecture 19: Orthopedic Infection Flashcards

1
Q

What are the clinical signs of orthopedic infection

A
  1. Lameness- progresses to NWB
  2. Swelling- synovial effusion, periarticular swelling
  3. What
  4. Maybe fever
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2
Q

S type synovial infection infects where

A

Synovial membrane/fluid

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3
Q

Where are S-type synovial infections commonly

A

Larger joints-stifle and tarsocrural

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4
Q

Where do E type epiphyseal infections infect

A

Synovial and Subchondral bone

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5
Q

Foals with E-type infection usually have a history of ___

A

Failure of passive transfer

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6
Q

Where does P type physeal infections infect

A

Primary infection of long bone but can extend into joint

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7
Q

What type of orthopedic infection is this

A

S-type (normal rad)

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8
Q

What type of orthopedic infection is this

A

E type.

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9
Q

What type of orthopedic infection is this

A

P type

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10
Q

What is the synovial fluid cell count in S type

A

> 50k cells/uL

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11
Q

What is synovial fluid total protein of S- type

A

> 2g/dl

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12
Q

Which type of septic arthritis has no bony abnormality on rads

A

S-type

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13
Q

What are some signs of S- type septic arthritis in foals

A

Lameness, joint effusion, fever

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14
Q

What are some signs of E-type septic arthritis in foals

A

Lameness, joint effusion, fever, hyperfribrinogenemia

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15
Q

What is affected on rads for E- type

A

Subchondral bone lysis

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16
Q

What are some signs of P type septic arthritis in foals

A

Lameness
NO JOINT EFFUSION
Periarticular edema
Hyperfibrinogenemia

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17
Q

What do rads show with P type

A

Bone lysis around and widening of growth plate

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18
Q

What are some diagnostics for all 3 types of septic arthritis

A
  1. CBC/chem, SAA
  2. Radiograph- all enlarged joints
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19
Q

What is the gold standard for diagnosis of S and E types

A

Positive culture

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20
Q

Why do positive cultures only occur in 50% of S and E types

A

Synovial fluid is very resistant against bacteria

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21
Q

Ultrasound of joint, what wrong

A

S and E types- septic arthritis

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22
Q

What is systemic tx for S and E types

A
  1. Broad spectrum antibiotic- K Pen-Gent
  2. Anti-inflammatories- banamine
  3. Ulcer prevention
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23
Q

Off NSAIDS for __hrs before discontinuing antibiotics for S and E types

24
Q

What are local tx for S and E types

A
  1. Collect culture before treatment if possible
  2. Joint lavage- 1-3 liters fluid and leave antibiotic (amikacin)
  3. Antibiotic tx- regional perfusion, PMMA beads, R gel
  4. IA hyaluronic acid
25
Q

What are R-gels

A

Can combine with antibiotics and make it last for 2 weeks

26
Q

T or F: you can put steroids in a septic joint

A

False- NEVER

27
Q

What is systemic treatment for P type

A
  1. Broad spectrum antibiotic
  2. Banamine
  3. Ulcer prevention
28
Q

What is local treatment for P type

A
  1. Collect culture before treatment
  2. Antibacterial therapy- regional perfusion, PMMA beads, R gel, inject lesion
29
Q

How do you do an IV regional perfusion

A
  1. Apply tourniquet
  2. Inject 50cc slowly via butterfly
  3. Leave 30 mins
  4. Treat vein topical with anti-inflammatories (DSMO)/bandage
30
Q

What are some treatment options for E and P types

A
  1. Surgical debridement
  2. Abx therapy
  3. Repeat joint lavage for E-type
31
Q

What types are these

32
Q

What are PMMA beads (polymethylmethacrylate)

A

Beads you can add antibiotics to and they diffuse over long periods

33
Q

What structure in foals do you also need to look at for cause of septic joints

34
Q

If you can’t lavage joint what do you do

A

Arthroscopy

35
Q

what’s wrong

A

Synovitis- fibrin accumulation

36
Q

Septic synovial structures in adults most commonly occur following __ or __

A

Puncture wounds or injections

37
Q

What bacteria are associated with puncture wounds causing septic synovial structures

A

Enterobacteria, staphylococcus, pseudomonas

38
Q

What bacteria are associated with post injection septic synovial structures

A

Staphylococcus

39
Q

__spread is rare in adults

A

Hematogenous

40
Q

In adults with septic synovial structures spread of infection from ___ to ___ occurs

A

Bone to joint

41
Q

Septic tenosynovitis is commonly from ___

A

Lacerations

42
Q

Simple lavage for septic tenosynovitis is often less effective than in joints so you should do __ or ___

A

Tenoscopy, synovectomy

43
Q

Septic tenosynovitis often require __ and ___into bandage

A

Drainage and lavage

44
Q

What is Sequestrum

A

Trauma to the bone that results in disruption to periosteum which disrupts blood supply to outer 1/3 of cortex, leads to a vascular necrosis and bone dies

45
Q

With a Sequestrum a ___forms exiting the skin

A

Draining tract

46
Q

What should you suspect in chronic non-healing wounds over bones

A

Sequestrum

47
Q

what is wrong and label arrows 1-3

A

Sequestrum
1. Sequestrum
2. Cloaca
3. Involcrum

48
Q

What is conservative treatment for Sequestrum

A

Long term antibiotics

49
Q

What is sx tx for Sequestrum

A

Debridement and removal
Wait for it to loosen

50
Q

___is a major consideration in fracture repair because lots of implanted material and long surgery times

A

Post-op infections

51
Q

What do you do to prevent post-op infections

A

Prevent during sx- prophylaxis antibiotic and lavage sx with abx containing fluids

52
Q

What is tx for post-op infection

A
  1. PMMA- under plate, mixed with amikacin
53
Q

What signs lead to diagnosis of post-op infection

A
  1. Lameness
  2. Prolonged discomfort despite analgesics
  3. Persistent swelling and inflammation
  4. Drainage
  5. Fever
54
Q

How do you tx infected implants

A

Systemic and local antibiotics

55
Q

If implants are unstable how do you tx infected implants

A

Remove, debridement

56
Q

If implants are stable how do you tx infected implants

A

Leave in, continue antibiotic therapy and once bone heals remove it

Equine Medicine and Surgery (27 decks)

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