Loco PBL 5: Osteomyelitis and Severs Disease Flashcards
What is Severs disease?
Calcaneal apophytis; Inflammation of the growth plate in the heel bone (calcaneus) of growing children due to repetitive stress to the heel
What are the symptoms of Severs disease?
Heel pain aggravated by physical activity on posterior, plantar side of the heel
What is the cause of Severs disease?
Overuse of the bones and tendons in the heel; due to the full of the calf muscles on the calcanea tendon that inserts into the calcaneal bone
What is a risk factor for Severs disease?
Over-pronating and being a child (as the heel bone grows quicker than the growth plate in the growth spurt). More common in boys too.
How is Severs disease diagnosed?
Medial-lateral compression of the calcaneus in the area of the growth plate (compression test) - if there is pain Severs disease is the likely cause ; alongside history and presentation
How is Severs disease treated?
RICE, stretching of hamstrings, and sometimes NSAIDs to relieve pain
What is the prognosis for Severs disease?
Will go away on its own with rest within 2-8 weeks
Why are children going through puberty at a greater risk of Severs disease?
Ad the growth plate in the heel hasn’t fused yet
What is the average age for Severs disease in boys?
9-11
When do girls go through puberty?
8-13 on average
When do boys go through puberty?
10-15 on average
What is osteomyelitis?
Infection and inflammation of the bone
What are the signs and symptoms of osteomyelitis?
Fever (38 degrees+), bone pain, unwell, affected part is tender , swelling, redness and warmth iat site
What is the cause of osteomyelitis?
Infection in the bone from bacteria (staphylococcus aureus is most common)
What bacteria may cause osteomyelitis?
Staphylococcus aureus (found in skin or nose), streptococcus pneumonia and streptococcus pyogenes
By what three pathways may bacteria invade the bone?
Haematogeneously (through the blood), contiguously (from local areas of infection) or from a penetrating trauma
Which part of the bone is most commonly implicated in osteomyelitis?
The metaphysis (contains growth plate); lies between the diaphysis (shaft) and epiphysis (tip) - this is because this area is highly vascular and has slow circulation in the metaphysical capillary loops (as there is growth here so the blood vessels are constantly being degenerated and formed) and therefore it’s easier for haematogeneous spread of infection
Describe the pathophysiology of osteomyelitis
Once bone is affected (by one of the routes), there is leukocyte invasion which engulf bacteria and release enzymes which degrade the bone. This causes pus to spread into the blood vessels supplying the bone which leads to impaired blood flow and malnourished bone known as sequestra. The bone will then try to form new bone around this sequestra/necrotic bon known as involcrum
What are sequestra formed in osteomyelitis?
A piece of dead bone tissue formed within a disease/injured bone, usually in osteomyelitis (these form the basis of chronic infection)
What are ‘involcrum’ formed in osteomyelitis?
The formation of new bone around a sequestrum/necrotic bone
How may osteomyelitis be diagnosed?
CRP/ESR elevated, WBC may be elevated, bacterial culture (blood/bone/joint aspirate), MRI or X-ray
How may an MRI illustrate osteomyelitis?
T2 weighted image shows increased marrow intensity with surrounding inflammation
How may an x-ray illustrate osteomyelitis?
If there is bone destruction (this tends to occur 2 weeks after infection)
How is osteomyelitis treated?
Antibiotics
How may flucloxacillin be used in the treatment of osteomyelitis?
It is a narrow-spectrum beta-lactam with activity against staphylococcus aureus as it’s beta lactase stablee
How may co-amoxiclav be used in the treatment of osteomyelitis?
Consists of amoxicillin trihydrate (beta-lactam antibiotic) and potassium clavulanate (beta lactamase inhibitor) to provide an increased spectrum of action
How may fusidic acid be used in the treatment of osteomyelitis?
A form of bacteriostatic antibiotic primarily effective against gram-positive bacteria; it inhibits bacterial replication but doesn’t directly kill the bacteria
What kind of bacteria is staphylococcus aureus and streptococcus?
Gram-positive bacteria
What is beta-lactamase?
Enzymes produced by bacteria that provide multi-resistance to beta lactam antibiotics
How long does treatment for osteomyelitis continue?
Until the CRP levels are back to normal which usually takes between 4-6 weeks
How may surgery be used to treat osteomyelitis?
Surgery and washout to remove bacterial infection and allow drainage
Why is iodine useful in the treatment of wounds?
Kills 90% of bacteria on the skin within 90 seconds including mould, yeast, protozoa, viruses, gram-negative and gram-positive bacteria and fungi
