Orthopaedic Infections Flashcards
soft tissue infection of the proximal or lateral nail folds; the most common hand infection
paronychia
what organism causes acute paronychia?
staph aureus
what pathogen causes paronychia in diabetic patients?
candida albicans
a patient presents with pain over the nail fold with erythema and swelling. Dx?
paronychia
what will be seen on physical exam of an acute paronychia? (3)
fluctuance
nail plate discoloration
nail fold tenderness + erythema
what pathogen should we think of when a patient’s physical exam shows green nail plates?
pseudomonas
what is the no-op treatment for an acute paronychia? (2)
warm soaks
oral antibiotics: augmentin or clindamycin
what is the operative treatment for an acute paronychia? (3)
I&D
partial/total nail bed removal
oral antibiotics: augmentin or clindamycin
what is the non-op treatment for a chronic paronychia? (2)
warm soaks
topical antifungal: miconazole
what is the op treatment for a chronic paronychia?
nail plate removal
subcutaneous abscesses of the fingertip pulp
felon
what is the common cause of a felon? organism?
trauma
staph aureus
a patient presents with severe throbbing over tip of finger with erythema and pain +/- fluctuance. PE has tenderness over finger tip and localized swelling over distal phalanx. Dx?
felon
when is an xray indicated for a felon? (2)
hx of trauma
r/o fracture or foreign body
what is the treatment for a felon without an abscess? (2)
oral antibiotics
f/u within 2 days
what is the treatment for a felon with an abscess? (3)
I&D
antibiotics
+/- hospital admission
infection along the flexor tendon sheath, caused either by penetrating trauma over the volar side of the finger or spread from a felon, septic joint, or deep infection
pyogenic flexor tenosynovitis
what are the 2 most common organisms that cause pyogenic flexor tenosynovitis?
staph aureus (#1)
MRSA (#2)
a patient presents with pain and swelling over flexor side of finger. Dx?
pyogenic flexor tenosynovitis
what are the 4 Kanavel’s signs for pyogenic flexor tenosynovitis?
pain with passive extension of finger
finger held in flexion for comfort
swelling of entire finger
TTP along flexor tendon sheath
what is the treatment for a pyogenic flexor tenosynovitis?
I&D by ortho
what is a diabetic wound infection that is a complication of peripheral neuropathy?
charcot neuro osteoarthropathy
what is the most common cause of charcot neuro osteoarthropathy?
diabetes mellitus
diabetic foot infections begin as soft tissue infections but can lead to what?
bone infections
what is the most common cause of nontraumatic LE amputation?
diabetic wound infections
what are the most common pathogens of diabetic wound infections? (3)
staph aureus
MSSA/MRSA
a patient presents with plantar wound ulcers, redness, warmth, induration, swelling, painless malodor, and purulence. Dx?
diabetic wound infection
what is the gold standard to evaluate for wound healing potential of diabetic wound infections?
transcutaneous oxygen pressures
a serum albumin level of > 3 in diabetic wound infections indicates what?
increased healing potential
what imaging helps identify abscess formation or osteomyelitis from diabetic wound infections?
MRI
what is the management for mild diabetic wound infections? (4)
outpatient
oral antibiotics
wound care
pressure off-loading
what is the management for moderate-severe diabetic wound infections? (3)
IV antibiotics
wound care
+/- surgical intervention
what is the most common complication following orthopaedic trauma surgery?
post-op wound infection
infection of the surgical site within 30 days, or 90 days if implant was used
post-op wound infection
what is the most common post-op wound infection organism?
staph aureus (half of those are MRSA)
a patient presents with cellulitis appearance on their leg, pain over surgical site, and erythema +/- drainage, +/- fever, chills, and night sweats. Dx?
post-op wound infection
what on physical exam of a patient with a post-op wound infection requires an urgent surgery consult?
hardware exposure
what is the most accurate diagnostic used for post-op wound infections?
deep cultures intra-operatively
what is the most predictive lab for post-op wound infections?
CRP
what should we do for all post-op wound infections?
refer to orthopaedic surgeon
what is the non-op treatment for post-op wound infections? (2)
oral antibiotics
wound care
what is the operative treatment for post-op wound infections? (3)
surgical debridement
oral antibiotics
+/- wound care
flesh-eating disease that is a life-threatening bacterial deep soft tissue infection that spreads along fascial planes rapidly
necrotizing fasciitis
post-surgery patients with which 2 co-morbidities have an increased risk for necrotizing fasciitis?
peripheral vascular disease
diabetes mellitus
what are the 3 common bacterial causes of necrotizing fasciitis? (3)
strep pyogenes
clostridium perfringens
vibrio
a patient presents with rapidly progressing erythema with tense edema, fever, tissue tenderness, and pain out of proportion to appearance of skin. Dx?
necrotizing fasciitis
what are 3 clinical features of necrotizing fasciitis that occur in the later stages?
tachycardia
hypotension
AMS
what is the scoring system used for necrotizing fasciitis?
Lrinec scoring system
what is the treatment for necrotizing fasciitis? (3)
emergency radial debridement
IV broad spectrum antibiotics
+/- extremity amputation
infection of the bone caused via bloodstream, cellulitis, or penetrating trauma
osteomyelitis
what is the most common organism that causes osteomyelitis?
staph aureus
what organism do sickle cell patients suffer from if they have osteomyelitis?
salmonella
what organism do infants suffer from if they have osteomyelitis? (2)
group A and B strep
what organism do DM patients suffer from if they have osteomyelitis?
pseudomonas
what is the most sensitive lab for osteomyelitis?
CRP
what imaging is best for diagnosing early osteomyelitis?
MRI - shows bone and soft tissue edema
what should we do for any patient with osteomyelitis?
refer to ortho for treatment
inflammation of the joint due to infection
septic joint infection
where in the body does septic joint infection most commonly occur? (3)
shoulder
hip
knee
what organism should we suspect to be the cause of septic joint infection in a healthy sexually active young adult?
neisseria gonorrhea
what is the most common organism that causes septic joint infection in all patients?
staph aureus
what is the most classic sign of septic joint infection?
inability to bear weight + pain with axial load
what is the gold standard for diagnosis and treatment of a septic joint infection?
joint aspiration
what lab level is diagnostic for septic arthritis?
WBC > 50,000
what is septic joint infection considered?
orthopaedic emergency
what is the treatment for septic joint infection? (2)
irrigation + debridement + intraoperative cultures
empiric broad spectrum IV antibiotics
what can delayed diagnosis of septic joint infection lead to?
cartilage damage within 8 hours
