Ortho Flashcards
what is trochanteric bursitis?
inflammation of a bursa over the greater trochanter on the outer hip
what is greater trochanteric pain syndrome?
pain localised at the outer hip caused by trochanteric bursitis
what are bursae
sacs created by synovial membrane filled with a small amount of synovial fluid
found at bony prominences
act to reduce friction between bones and soft tissue during movement
what is bursitis
inflammation of a bursa. Causes thickening of the synovial membrane and increased fluid production, causing swelling
4 causes of bursitis
- friction from repetitive movements
- trauma
- inflammatory conditions e.g. RA
- infection (septic bursitis)
presentation of trochanteric bursitis
- middle aged patient with gradual onset lateral hip pain that may radiate down outer thigh
- aching or burning pain
- worse with activity,
standing after sitting for a prolonged period and trying to sit cross-legged - disrupted sleep. difficult to find a comfortable lying position
- tenderness over the greater trochanter. No swelling
name 4 special tests to establish a dx of trochanteric bursitis
1. +ve Trendelenburg test Pain on: 2. resisted abduction of the hip 3. resisted internal rotation of the hip 4. resisted external rotation of the hip
what does the Trendelenburg test involve?
establishes dx of trochanteric bursitis
stand one legged on the affected leg
normally the other other side of the pelvis should remain level or tilt upwards slightly
+ve Trendelenburg test: other side of pelvis drops down –> weakness in the affected hip
Management options for trochanteric bursitis
- rest
- ice
- analgesia NSAIDs
- Physiotherapy
- Steroid injections
- abx if caused by infection
septic bursitis presentation
- warmth, erythema, swelling and pain over the bursa
- may have fever
what is the recovery period for trochanteric bursitis
6-9m
what is trigger finger?
a condition causing pain and difficulty moving a finger
aka stenosing tenosynovitis
what is the pathophysiology of trigger finger?
- flexor tendons of finger pass through sheaths along length of finger
- thickening of tendon or tightening of sheath
- prevents tendon from smoothly moving through the sheath when finger is flexed and extended
- causing pain, stiffness or catching symptoms
what is the most commonly affected part of the sheath in trigger finger?
first annular pulley (A1)
at the MCP joint
what are the RFs for trigger finger?
- 40s or 50s
- women
- diabetics
what is the typical presentation of trigger finger?
troublesome finger that:
- is painful + tender (usually around the MCP joint on the palm-side of the hand
- does not move smoothly
- makes a popping or clicking sound
- gets stuck in a flexed position
Sx typically worse in morning and improve during the day
how to diagnose trigger finger
clinical diagnosis based on hx and examination
what are the management options for trigger finger
- rest and analgesia (some resolve spontaneously)
- splinting
- steroid injections
- surgery to release A1 pulley
what is a Baker’s cyst?
aka popliteal cysts
a fluid filled sac in the popliteal fossa, causing a lump
what are the borders of the popliteal fossa?
- superior + medial: Semimembranous and semitendinosus tendons
- superior + lateral: Biceps femoris tendon
- inferior + medial: medial head of the gastrocnemius
- inferior + lateral: lateral head of the gastrocnemius
what causes Baker’s cysts?
in adults, it’s usually secondary to degenerative changes in the knee joint
Synovial fluid squeezed out of knee joint
collects in popliteal fossa
a connection between the synovial fluid in the joint and Baker’s cyst can remain
allowing cyst to continue to enlarge as more fluid collects there
what are Baker’s cysts associated with?
- MENISCAL TEARS
- osteoarthritis
- knee injuries
- inflammatory arthritis e.g. RA
do Baker’s cysts have their own epithelial lining?
No but they are contained within the soft tissues
presentation of Baker’s cysts
Localised to popliteal fossa:
- pain or discomfort
- fullness
- pressure
- palpable lump or swelling
- restricted range of motion in the knee (with larger cysts)
- oedema if cyst compresses the venous drainage of the leg
What is Foucher’s sign
the Baker’s cyst lump will get smaller or disappear when the knee is flexed to 45 degrees
What does a ruptured Baker’s cyst present as?
inflammation in the surrounding tissues and calf muscles - pain - erythema - swelling rarely can cause compartment syndrome
name a critical differential diagnosis of a ruptured Baker’s cyst?
DVT
Name key differential diagnoses of a lump in the popliteal fossa
- DVT
- Abscess
- Popliteal artery aneurysm
- Ganglion cyst
- Lipoma
- Varicose veins
- Tumour
1st line Inx for a Baker’s cyst
US confirms dx and rules out DVT
2nd line inx for a Baker’s cyst
MRI can evaluate cyst further if required before surgery.
And demonstrate any underlying knee pathology e.g. meniscal tears
Management for asymptomatic Baker’s cysts
none
Management for symptomatic Baker’s cysts
- modified activity to avoid exacerbating sx
- NSAIDs
- Physiotherapy
- US-guided aspiration
- Steroid injections
Surgical: arthroscopic procedures to treat underlying knee pathology
What is compartment syndrome?
Pressure within a fascial compartment is abnormally elevated, cutting off the blood flow of the contents of that compartment
what do fascial compartments involve?
- muscles
- nerve
- blood vessels
surrounds by fascia
what is fascia?
a sheet of strong, fibrous connective tissue that encases the contents of the compartment
Not able to stretch or expand
what is required in acute compartment syndrome?
Ortho emergency:
Fasciotomy
what does a fasciotomy do?
relieve pressure within the compartment and restore blood flow by cutting through the fascia down the entire length of the compartment
compartment is explored to identify and debride any necrotic muscle tissue
wound is left open and covered with a dressing
what happens if acute compartment syndrome isn’t treated?
tissue necrosis and permanent damage
what is acute compartment syndrome usually associated with?
Acute injury where bleeding or oedema associated with the injury increases the pressure within the compartment
- bone fractures
- crush injuries
presentation of acute compartment syndrome
5 P’s
- Pain - disproportionate to the underlying injury, worsened by passive stretching of the muscle
- Paraesthesia
- Pale
- Pressure (high)
- Paralysis (a late worrying feature)
what is the difference between acute limb ischaemia and acute compartment syndrome
in acute compartment syndrome, the pulses may remain intact depending on which compartment is affected
how to diagnose acute compartment syndrome
primary a clinical diagnosis
needle manometry can be used to measure the compartment pressure. Manometer measures the resistance to injecting saline through a needle into the compartment
what is the initial mnx of acute compartment syndrome?
- escalate to ortho reg/consultant
- remove any external bandages
- elevate the leg to heart level
- maintaining good blood pressure (avoiding hypotension)
what is the definitive mnx for acute compartment syndrome?
emergency fasciotomy
Compartment syndrome
what happens after the fasciotomy
Pts require repeated trips every few days to theatre to explore the compartment for necrotic tissue which needs to be debrided
wound can take several weeks to close. May need skin graft
what is chronic compartment syndrome
aka chronic exertional compartment syndrome
exertion –> pressure within compartment rises –> blood flow to compartment is restricted –> symptoms
rest –> pressure falls –> symptoms resolve
not an emergency
Sx in chronic compartment syndrome
pain, numbness or paresthesia in affected compartment
made worse by increasing activity and resolve quickly with rest
how to confirm diagnosis of chronic compartment syndrome
needle manometry - measures pressure in compartment before, during and after exertion
treatment for chronic compartment syndrome
fasciotomy
Pathophysiology of Osgood-Schlatter Disease
caused by inflammation at the tibial tuberosity where the patella ligament inserts
multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of the bone
leads to growth of the tibial tuberosity, causing a visible lump below the knee
initially this lump is tender due to inflammation. As the bone heals and inflammation settles, the lump becomes hard and non-tender
epidemiology of Osgood-Schlatter Disease
typically occurs in patients aged 10-15yrs
more common in males
presentation of Osgood-Schlatter Disease
gradual onset of symptoms:
- visible or palpable hard and tender lump at the tibial tuberosity
- pain in the anterior aspect of the knee
- pain is exacerbated by physical activity, kneeling and on extension of the knee
management of Osgood-Schlatter Disease
initially:
- reduce physical activity
- ice
- NSAIDs
once sx settle:
- stretching
- physio
prognosis of Osgood-Schlatter Disease
- sx will fully resolve over time
- left with a hard bony lump on knee
rare complication of Osgood-Schlatter Disease
a complete avulsion fracture: the tibial tuberosity is separated from the rest of the tibia. Requires surgical intervention
what is an Achilles Tendon Rupture?
a sudden onset injury resulting in rupture of the Achilles tendon and a loss of the connection between the calf muscles (gastrocnemius + soleus) to the heel (calcaneus bone)
what are the RFs for an Achilles Tendon Rupture
- sports that stress the Achilles e.g basketball, tennis, track
- increasing age
- existing Achilles tendinopathy
- family history
- Fluoroquinolone abx e.g. ciprofloxacin + levofloxacin)
- Systemic steroids
what is fluoroquinolone abx such as ciprofloxacin + levofloxacin associated with?
Achilles tendinopathy + rupture
rupture can occur spontaneously within 48 hrs of starting trx
stop trx if it occurs
presentation of an Achilles Tendon Rupture
- sudden onset of pain in the Achilles or calf
- a snapping sound and sensation
- feeling as though something has hit them in the back of the leg
signs on examination of an Achilles Tendon Rupture
- when relaxed in a dangled position, the affected ankle will rest in a more dorsiflexed position
- tenderness to the area
- a palpable gap in the Achilles tendon (swelling may hide this)
- weakness of plantar flexion of the ankle (dorsiflexion is unaffected)
- unable to stand on tip toes on the affected leg alone
- +ve Simmonds’ calf squeeze test
what is the Simmonds’ calf squeeze test
the special test for Achilles tendon rupture
squeeze calf hanging off bed
+ve if lack of plantar flexion
immediate mnx of Achilles Tendon Rupture
- reviewed by orthopaedics on same day
- rest + immobilisation
- Ice
- Elevation
- Analgesia
- VTE prophylaxis considered while ankle is immobilised
non-surgical mnx of an Achilles Tendon Rupture
- specialist boot to immobilise ankle
- 1st boot: full planter flexion of ankle
- over 6-12w boot gradually moves ankle to neutral position
- long rehab process required to get back to full pre-injury function
- higher risk of re-rupture compared to surgical mnx
surgical mnx of Achilles Tendon Rupture
reattaches the Achilles –> boots –> rehab
Where does the anterior cruciate ligament attaches to on the tibia?
anterior intercondylar area
Where does the posterior cruciate ligament attach to on the tibia?
posterior intercondylar area
function of the ACL
it stops the tibia from sliding forward in relation to the femur
function of the PCL
it stops the tibia sliding backwards in relation to the femur
How is the ACL damaged?
during a twisting injury to the knee
presentation of an anterior cruciate ligament injury
- pain
- swelling
- ‘pop’ sound or sensation
- instability of knee joint
- tibia can move anteriorly below the femur
- the knee can buckle
- increased risk of other knee injuries
name 2 special tests to assess for anterior cruciate ligament damage
- the anterior drawer test
- Lachman test
describe the anterior drawer test
- patient supine
- hip flexed to 45
- foot flat on couch
- Dr sits on toes
- Dr pulls proximal tibia anteriorly, sliding it forward from the femur at the knee
with ACL damage, the tibia can move an excessive distance anteriorly + no clear end-point to the movement
what’s the difference between the anterior drawer test and Lachman test
Lachman: knee is flexed at around 20-30 degrees
inx for ACL injury
1st line + diagnostic: MRI
gold standard to diagnose a cruciate ligament tear: Arthroscopy
symptoms suggestive of an acute ACL tear
- a ‘pop’
- rapid onset swelling
- instability or giving way
Mnx of ACL injury
- RICE
- NSAIDs
- crutches + knee braces: help protect knee while mobilising
- physio
- arthroscopic surgery
ACL injury
what happens in arthroscopic surgery
a new ligament is formed using a graft tendon from:
- hamstring tendon
- quadriceps tendon
- bone-patellar tendon-bone
What is DeQuervain’s Tenosynovitis?
swelling + inflammation of the tendon sheaths in the wrist
a type of repetitive strain injury
results in pain on the radial side of the wrist
what tendons are affected in DeQuervain’s Tenosynovitis
- Abductor pollicis longus (APL)
- Extensor pollicis brevis (EPB)
name a cause of bilateral DeQuervain’s Tenosynovitis
‘mummy thumb’ in new parents repetitively lifting newborn babies in a way that stresses the tendons of the thumb
what does the abductor pollicus longus do?
abduct the thumb and wrist
where does the abductor pollicus longus insert into
the base of the 1st metacarpal bone (at the base of the thumb)
what does the extensor pollicis brevis do?
also abducts the thumb and wrist
where does the extensor pollicis brevis insert into?
the base of the proximal phalanx of the thumb
what do tendon sheaths do?
surround tendons.
formed by connective tissue (synovial membrane) that covers the tendons + filled with synovial fluid
they help lubricate + protect the movement of tendons within them
what is the extensor retinaculum?
a fibrous band that wraps across the back (dorsal) side of the wrist
the APL + EPB pass underneath it
what is the pathophysiology of DeQuervain’s Tenosynovitis
repetitive movement of the APL + EPB under the extensor retinaculum result in inflammation + swelling of the tendon sheaths
presentation of DeQuervain’s Tenosynovitis
symptoms at radial aspect of wrist near base of thumb:
- pain, often radiating to forearm
- aching
- burning
- weakness
- numbness
- tenderness
what is the special test for DeQuervain’s Tenosynovitis
Finkelstein’s test (or maybe called Eichhoff’s test)
What is Finkelstein’s test?
pt makes fist with thumb inside fingers
adduct wrist
if this causes pain at the radial aspect of the wrist, the test is +ve —> De Quervain’s tenosynovitis
mnx of De Quervain’s tenosynovitis
- rest + adapting activities
- splints to restrict movements
- NSAIDs
- physio
- steroid injections
- Rare: surgery to release the extensor retinaculum to release pressure + create more space for tendons
FROZEN SHOULDER
Pathophysiology
aka adhesive capsulitis
inflammation + fibrosis in the joint capsule lead to adhesions
adhesions bind the capsule + cause it to tighten around the joint, restricting movement in the joint
what is primary adhesive capsulitis
(frozen shoulder)
occurring spontaneously without any trigger
what is secondary adhesive capsulitis
(frozen shoulder)
occurring in response to trauma, surgery or immobilisation
what is a key risk factor of frozen shoulder?
diabetes
describe the typical course of symptoms of frozen shoulder in 3 phases
Painful phase: shoulder pain is often the 1st symptom + may be worse at night
Stiff phase: shoulder stiffness develops + affects both active and passive movement (external rotation is the most affected). The pain settles during this phase
Thawing phase: gradual improvement in stiffness + a return to normal
how long does frozen shoulder last for?
1-3 years
but up to 50% have persistent symptoms
name 3 differential diagnoses in a patient presenting with shoulder pain not preceded by trauma or an acute injury
- Supraspinatus tendinopathy
- Acromioclavicular joint arthritis
- Glenohumeral joint arthritis
name 3 rare but important differentials of shoulder pain not preceded by trauma
- septic arthritis
- inflammatory arthritis
- malignancy e.g. osteosarccoma or bony metastasis)
name 3 differentials for shoulder pain
- shoulder dislocation
- fractures e.g. proximal humerus, clavicle or rarely the scapula)
- rotator cuff tear
what is supraspinatus tendinopathy?
inflammation + irritation of the supraspinatus tendon
particularly due to impingement at the point where it passes between the humeral head + the acromion
what test can be used to assess for supraspinatus tendinopathy?
the empty can test aka Jobe test
+ve if pain or arm gives way
Acromioclavicular joint arthritis signs on examination (3)
- tenderness to palpation of the AC joint
- Pain is worse at the extremes of the shoulder abduction, from around 170 degrees onwards when the arm is overhead
- +ve scarf test: pain caused by wrapping arm across chest + opposite shoulder
diagnosing adhesive capsulitis (frozen shoulder)
clinical, no imaging usually required
X-rays are normal but helpful in diagnosing osteoarthritis as a differential
US, CT or MRI can show a thickened joint capsule
non surgical mnx for adhesive capsulitis (frozen shoulder)
- continue using arm but don’t exacerbate pain
- NSAIDs
- physio
- intra-articular steroid injections
- hydrodilation (injecting fluid into the joint to stretch the capsule)
surgical mnx for adhesive capsulitis (frozen shoulder)
- manipulation under anaesthesia: forcefully stretching the capsule to improve the range of motion
- arthroscopy: keyhole surgery on the shoulder to cut the adhesions + release the shoulder
Dupuytren’s Contracture
Pathophysiology?
the palmar fascia of the hands becomes thicker + tighter + develops nodules
cords of dense connective tissue can extend into the fingers, pulling the fingers into flexion + restricting their ability to extend (contracture)
Dupuytren’s Contracture
why does the palmar fascia become thicker and tighter
unclear but thought to be an inflammatory process in response to microtrauma
Dupuytren’s Contracture
Risk factors?
- age
- FH (autosomal dominant)
- male
- manual labour, esp vibrating tools
- diabetes
- epilepsy
- smoking + alcohol
Dupuytren’s Contracture
Presentation?
- 1st sign: hard nodules on palm
- finger pulled into flexion
- can’t extend finger fully
- significantly affects function
Dupuytren’s Contracture
what finger is most and least likely to be affected
most: ring finger
least: index
Dupuytren’s Contracture
special test?
the table-top test
+ve if hand cannot rest completely flat on table
Dupuytren’s Contracture
Management?
- do nothing
- needle fasciotomy (aka needle aponeurotomy): insert needle to loosen cord causing contracture
- limited fasciectomy: remove abnormal fascia + cord to release contracture
- dermofasciectomy: remove abnormal fascia + cord + skin. Skin graft replaces removed skin
compound fracture?
when the skin is broken + the broken bone is exposed to the air.
the broken bone can puncture through the skin
stable fracture?
when the sections of bone remain in alignment at the fracture
pathological fracture?
when a bone breaks due to an abnormality within the bone
e.g. tumour, osteoporosis, Paget’s disease
terms used to describe what way a bone breaks
- transverse
- oblique
- spiral
- segmental
- comminuted
- compression fractures
- greenstick
- buckle (torus)
- Salter-Harris
Fractures
comminuted?
breaking into multiple fragments
Fractures
compression fractures?
affecting the vertebrae in the spine
Greenstick and buckle fractures typically occur in children or adults?
children
Fractures
Salter-Harris
growth plate fracture
only occur in children as adults don’t have growth plates
Colle’s fracture
- a transverse fracture of the distal radius near the wrist
- causing the distal portion to displace posteriorly (upwards)
- causing a ‘dinner fork deformity’
- usually the result of a fall onto an outstretched hand (FOOSH)
what causes a scaphoid fracture?
fall onto an outstretched hand (FOOSH)
scaphoid fracture sign
tenderness in the anatomical snuffbox
what is a complication of a scaphoid fracture and explain
avascular necrosis + non-union
because the scaphoid has a retrograde blood supply with blood vessels supplying the bone from only one direction
this means a fracture can cut off the blood supply
name some bones with a vulnerable blood supply where a fracture can lead to avascular necrosis , impaired healing + non-union
- scaphoid bone
- femoral head
- humeral head
- talus, navicular + 5th metatarsal in the foot
what do ankle fractures involve?
- lateral malleolus (distal fibula)
- medial malleolus (distal tibia)
what is the Weber classification?
used to describe fractures of the lateral malleolus (distal fibula)
the fracture is described in relation to the distal syndesmosis (fibrous joint) between the tibia and fibula
what is the tibiofibular syndesmosis
important for stability + function of the ankle joint
if a fracture disrupts it, surgery is more likely to be required
Weber classification
Type A
below the ankle joint - will leave the syndesmosis intact
Weber classification
Type B
at the level of the ankle joint - the syndesmosis will be intact or partially torn
Weber classification
Type C
above the ankle joint - the syndesmosis will be disrupted
Pelvic Ring fracture?
- the pelvis forms a ring
- when 1 part fractures, another part will also fracture (like a polo mint)
complications of a pelvic ring fracture
- intra-abdominal bleeding due to vascular injury or from the cancellous bone of the pelvis
- can lead to shock + death
what are common sites of pathological fractures?
femur and the vertebral bodies
what cancers metastasise to bone?
PoRTaBLe Po - prostate R - renal Ta - Thyroid B - breast Le - Lung
Ganglion Cysts
what are they?
sacs of synovial fluid that originate from the tendon sheaths or joints
Ganglion Cysts
where do they commonly occur?
wrist + fingers but can occur anywhere there is a joint or tendon sheath
Ganglion Cysts
pathophysiology
when the synovial membrane of the tendon sheath or joint herniates, forming a pouch
synovial fluid flows from the tendon sheath or joint into the pouch, forming a cyst
Ganglion Cysts
presentation
- visible and palpable lump
- not painful
- can appear rapidly or gradually
- rare: compresses nerves leading to sensory or motor symptoms
Ganglion Cysts
examination findings
- 0.5-5cm usually
- firm + non-tender on palpation
- well-circumscribed
- trans illuminates
Ganglion Cysts
diagnosis
- clinically !
- x-rays: normal bones + joints
- US: may help confirm dx + exclude other causes of lumps
Ganglion Cysts
mnx
- conservatively: 40-50% resolve spontaneously but can take several years
- needle aspiration
- surgical excision
Ganglion Cysts
disadvantage of needle aspiration for mnx
high rate of recurrence (50% or more)
Ganglion Cysts
pros and cons of surgical excision for mnx
+ recurrence rate is low
- infection, scarring
Fractures
cause of fragility fractures
weakness in the bone usually due to osteoporosis
Fractures
what is the FRAX tool
a patient’s risk of a fragility fracture over the next 10 years
Fractures
how can bone mineral density be measured?
with a DEXA scan
Fractures
T score of more than -1
normal
Fractures
T score of -1 to -2.5
osteopenia
Fractures
T score of less than -2.5
osteoporosis
Fractures
T score of less than -2.5 plus a fracture
severe osteoporosis
Fractures
1st line medical treatments for reducing the risk of fragility fractures
- Calcium + Vit D
- Bisphosphonates e.g. alendronic acid
Fractures
how do bisphosphonates work
they reduce osteoclast activity, preventing the reabsorption of bone
Fractures
side effects of bisphosphonates
- reflux and oesophageal erosions
- atypical fractures
- osteonecrosis of the jaw
- osteonecrosis of the external auditory canal
Fractures
instruction to patients taking biphosphonates
- take on an empty stomach
- sit upright for 30 min before moving or eating
Fractures
alternative to bisphosphonates where they are CI’d, not tolerated or not effective
Denosumab - a monoclonal antibody that blocks the activity of osteoclasts
Fractures
inx for suspected bone fracture
X-rays - 2 views are always required as a single view may miss a fracture
CT: more detailed view of bones when the x-rays are inconclusive or further info needed
Fractures
principles of fracture mnx
- achieve mechanical alignment
2. provide relative stability for some time to allow healing to occur
Fractures
how to achieve mechanical alignment of the fracture
- closed reduction via manipulation of the limb
- open reduction via surgery
Fractures
how to provided relative stability in a fracture
fix bone in correct position while it heals:
- external casts
- K wires
- Intramedullary wires
- intramedullary nails
- screws
- plates + screws
Fractures
what are complex fractures
those requiring surgery e.g. hip fractures
referred to the on-call trauma + orthopaedic team
Fractures
possible early complications
- damage to local structures
- haemorrhage leading to shock + potentially death
- compartment syndrome
- fat embolism
- VTE
Fractures
possible longer-term complications
- delayed union (slow healing)
- malunion (misaligned healing)
- non-union (failure to heal)
- avascular necrosis (death of bone)
- infection (osteomyelitis)
- joint instability
- joint stiffness
- contractures
- arthritis
- chronic pain
- complex regional pain syndrome
Fractures
how can a fracture of a long bone cause a fat embolism
fat globules are released into the circulation following a fracture (possibly from the bone marrow)
these globules may become lodged in blood vessels and cause blood flow obstruction
Fractures
what is fat embolism syndrome
fat embolisation can cause a systemic inflammatory response resulting in a fat embolism syndrome
Fractures
what is Gurd’s MAJOR criteria for the diagnosis of a fat embolism
- resp distress
- petechial rash
- cerebral involvement
Fractures
name some of Gurd’s MINOR criteria
- jaundice
- thrombocytopenia
- fever
- tachycardia
Fractures
mnx of fat embolism
supportive
operate early to fix the fracture reduces the risk of fat embolism syndrome
Osteomyelitis
what is it
inflammation in a bone and bone marrow, usually caused by bacterial infection
Osteomyelitis
what is haematogenous osteomyelitis
when a pathogen is carried through the blood and seeded in the bone
this is the most common mode of infection
Osteomyelitis
causes
- haematogenous osteomyelitis
- direct contamination of the bone: fracture site, ortho operation
Osteomyelitis
what organism causes most cases
Staphylococcus aureus
Osteomyelitis
types
acute or chronic
Osteomyelitis
RFs (6)
- open fractures
- orthopaedic operations. esp prosthetic joints
- diabetes, esp foot ulcers
- peripheral artery disease
- IV drug use
- immunosuppression
Osteomyelitis
what measures are taken to prevent infection in prosthetic joints
perioperative prophylactic abx
it’s more likely to occur in revision surgery rather than during initial joint replacement
Osteomyelitis
presentation (4)
- fever
- pain + tenderness
- erythema
- swelling
Osteomyelitis
potential signs on an x-ray
often no changes
- Periosteal reaction
- Localised osteopenia
- Destruction of areas of the bone
Osteomyelitis
x-ray: what is periosteal reaction
changes to the surface of the bone
Osteomyelitis
x-ray: what is localised osteopenia
thinning of the bone
Osteomyelitis
what is the best imaging inx for establishing dx
MRI
Osteomyelitis
what will blood tests show
raised inflammatory markers (WBC, ESR, CRP)
Osteomyelitis
what may blood cultures show
may be positive for causative organism (usually staph aureus)
Osteomyelitis
what can be performed to establish the causative organism and the abx sensitivities
bone cultures
Osteomyelitis
mnx
a combination of
-surgical debridement of the infected bone + tissues
- abx therapy
