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MSK > Lecture 4 Infection in Bone and Joints > Flashcards

Lecture 4 Infection in Bone and Joints Flashcards

1
Q

What group of people are more prone to osteomyelitis

A

Boys

Children

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2
Q

What are the risk factors for osteomyelitis

A 
DM
Rheumatoid arthritis
Immune compromise
Long term steroid use
Sickle cell
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3
Q

What are the sources of infection for osteomyelitis in children and elderly

A

Haematogenous- children and elderly

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4
Q

What are the sources of infection for osteomyelitis in trauma

A 
•	Local spread from contiguous site of infection
o	Trauma (open fracture)
o	Bone surgery
o	Joint replacement
•	Secondary to vascular insufficiency
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5
Q

What are the sources of infection for osteomyelitis in infants

A

Infected umbilical cord

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6
Q

What are the sources of infection for osteomyelitis in children

A

Boils
Tonsilitis
Skin abrasions

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7
Q

What are the sources of infection for osteomyelitis in adults

A

UTI

Arterial line

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8
Q

Name 3 common organisms that affect infants <1 who have osteomyelitis

A

o Staph aureus
o Group B streptococci
o E. coli

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9
Q

Name 3 common organisms that affect older children who have osteomyelitis

A

o Staph aureus
o Strep pyogenes
o Haemophilus influenza- immunisation significantly reduced

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10
Q

Name 3 common organisms that affect adults who have osteomyelitis

A 
o	Staph aureus
o	Pseudomonas aeruginosa
-	Immunocompromised
-	Trainer’s foot- penetrating foot injuries
-	IVD
o	Coagulase negative staphylococci
-	Prostheses 
o	Propionibacterium spp.
-	Shoulder replacements
-	Prostheses
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11
Q

What organism causes osteomyelitis in diabetic foot and pressure sores

A

Mixed infection including anaerobes

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12
Q

What organism causes osteomyelitis in vertebral osteomyelitis

A

Staph aureus

TB

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13
Q

What organism causes osteomyelitis is Sickle Cell Disease

A

Salmonella spp.

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14
Q

Candida causes osteomyelitis in what groups of people

A

HIV/AIDs
Long term antibiotic treatment
Extensive GI surgery
Malignancy

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15
Q

What part of the bone does osteomyelitis start

A

Metaphysis

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16
Q

What are the clinical features of osteomyelitis in an infant

A
  • Failure to thrive
  • Drowsy or irritable
  • Metaphyseal tenderness and swelling
  • Decrease ROM
  • Positional change- may be flexed
  • Commonest around the knee
  • Often multiple sites
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17
Q

What are the clinical features of osteomyelitis in children

A
  • Severe pain
  • Reluctant to move
  • Fever (swinging pyrexia) + tachycardia
  • Malaise (fatigue, nausea, vomiting, fretful)
  • Toxaemia
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18
Q

What are the clinical features of osteomyelitis in adults

A

Backache
History of UTI or urological procedure
Often after open fracture

19
Q

How is osteomyelitis diagnosed

A 
History and clinical examination
FBC and WBC (neutrophil leucocytosis)
Blood culture
U&amp;Es
X-Ray
US
Aspiration
Isotope bone scan
Labelled white cell scan
MRI
20
Q

What are the differential diagnosis of osteomyelitis

A
  • Acute septic arthritis
  • Trauma (fracture, dislocation)
  • Acute inflammatory arthritis
  • Transient synovitis (irritable hip)
21
Q

What is the treatment of osteomyelitis

A

Supportive
Rest and splintage
Antibiotics
Surgery (debridement, drainage, infected joint replacements)

22
Q

Name complications of osteomyelitis

A
  • Metastatic infection
  • Pathological fracture
  • Septic arthritis
  • Septicaemia, death
  • Altered bone growth
  • Chronic osteomyelitis
23
Q

Name the causes of Chronic Osteomyelitis

A 
Follow acute osteomyelitis
De novo
o	Following operation
o	Following open fractures
o	Immunosuppressed, diabetics, elderly, drug abusers
24
Q

Name common organisms that cause osteomyelitis

A 
Often mixed
Staph aureus
E.coli
Strep pyogenes
Proteus
25
What is the pathology of chronic osteomyelitis
Cavities, possibly sinuses Dead bone Involucrum
26
How is chronic osteomyelitis treated
``` Long term antibiotics Local- gentamicin Systemic Surgical Deformity correction Amputation ```
27
Complications of chronic osteomyelitis
* Chronically discharging sinus and flareups * Ongoing (metastatic) infection (abscesses) * Pathological fracture- never heal * Growth disturbance (deformities)- damage of growth plate * SCC
28
Name the routes of infection of Septic arthritis
Haematgenous Eruption of bone abscess Direct invasion
29
Organisms responsible for septic arthritis
* Staph aureus * Haemophilus influenzae * Strep pyogenes * E. coli- neonates or very old
30
What are the clinical presentation of septic arthritis in neonates
* Picture of septicaemia * Irritability * Resistant to movement
31
What are the clinical presentation of septic arthritis in child and adults
* Reluctant to move the joint * Swelling-seen in superficial joint * Not erythema- unless superficial and later * Increase temp. and pulse
32
What are the clinical presentation of septic arthritis in adults
* Increase tenderness * Often involves superficial joint (knee, ankle, wrist) * Rare in healthy adult * May be delayed diagnosis
33
How is septic arthritis diagnosed
* FBC, WBC, ESR, CRP, blood cultures * X ray * Ultrasound * MRI * Aspiration
34
What is the most common cause of septic arthritis
Infected joint replacement
35
Differential diagnosis of septic arthritis
* Acute osteomyelitis * Trauma * Irritable joint * Haemophilia * Rheumatic fever * Gout * Gaucher’s disease
36
How is septic arthritis treated
Supportive Antibitiotics (3-4 weeks) Surgical drainage and lavage Infected joint replacements
37
What are the classifications of tuberculosis bone infection
Extra articular Intra articular Vertebral body
38
What are the clinical features of a tuberculosis bone infection
* Pain (especially at night), swelling, weight loss (confused with bone tumours) * Low grade pyrexia * Joint swelling * Decrease ROM * Ankylosis * Deformity
39
What is the commonest TB bone infection
Spinal TB
40
What are the clinical features of Spinal YB
Little pain | Abscess or kyphosis
41
What are the investigations for TB bone infections
* FBC, ESR * Mantoux test * Sputum/urine culture * X-ray * Joint aspiration and biopsy
42
What is the differential diagnosis of TB bone infection
* Transient synovitis * Monoarticular RA * Haemorrhagic arthritis * Pyogenic arthritis
43
What is the treatment for a TB bone infection
• Chemotherapy initially for 8 weeks: o Rifampicin o Isoniazid o Ethambutol • Then rifampicin and isoniazid 6-12 months • Rest and splintage • Operative drainage/fusion rarely necessary

MSK (33 decks)

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