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MSK Pathology > Orthopaedic Infections > Flashcards

Orthopaedic Infections Flashcards

1
Q

What type of bone does osteomyelitis affect?

A

compact, spongy and bone marrow

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2
Q

What is infection in osteomyelitis usually caused by?

A

bacteria, occasionally fungal

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3
Q

How can organisms infect bone in osteomyelitis?

A

trauma, surgery or indirectly by haematogenous spread

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4
Q

In osteomyelitis, what causes osteolysis?

A

enzymes from leukocytes

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5
Q

What impairs local blood flow in osteomyelitis, making it hard to eradicate?

A

pus formation

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6
Q

What is the name for a dead fragment of bone which can form in osteomyelitis which usually breaks off?

A

sequestrium

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7
Q

At what point in osteomyelitis will antibiotics alone not cure the infection?

A

once an equestrium has formed

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8
Q

What is the name for new bone which will form around the area of necrosis in osteomyelitis?

A

an involucrum

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9
Q

In the absence of recent surgery, who is acute osteomyelitis likely to occur in?

A

children or immunocompromised

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10
Q

In children, what to the metaphyses of long bones contain which can result in accumulation of bacteria and infection spreading towards the epiphysis?

A

abundant tortuous vessels with sluggish flow

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11
Q

In neonates and infants, certain metaphyses are intra articular, including what? What does this mean can happen?

A

proximal femur, proximal humerus, radial head and ankle

infection can spread into joint causing septic arthritis to also occur

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12
Q

What do infants have which may cause an abscess to extend widely along the subperiosteal space?

A

loosely applied periosteum

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13
Q

What is Brodie’s abscess?

A

children develop subacute osteomyelitis with a more insidious onset, where bone reacts by walling off the abcess with a thin rim of sclerotic bone

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14
Q

What does chronic osteomyelitis develop from?

A

untreated acute osteomyelitis

can be associated with a sequestrum/involucrum

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15
Q

In adults, where does chronic osteomyelitis tend to be?

A

axial skeleton with haematogenous spread from pulmonary or urinary infections

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16
Q

What may be a cause of peripheral chronic OM?

A

internal fixation or previous open fracture

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17
Q

What can cause chronic OMG particularly in the spine through haematogenous spread from primary lung infection?

A

TB

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18
Q

Name the causative organisms for osteomyelitis in newborns (younger than 4 months).

A

Staph aureus, enterobacter sp, and group A and B strep

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19
Q

Name the causative organisms for osteomyelitis in children (4 months to 4 yrs).

A

staph aureus, enterobacter sp, group A strep, haemo influenza (reduced with vaccine),

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20
Q

Name the causative organisms for osteomyelitis in children aged 4 to adults?

A

staph aureus

occasionally enterobacter or streptococcus

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21
Q

Name the causative organisms for osteomyelitis in sickle cell anaemia patients.

A

Staph aureus most common, also Salmonella (unique to sickle cell patients)

22
Q

How can osteomyelitis be classed?

A

superficial (affects outer surface of bone) OR medullary
localized
diffuse (segment of bone is infected leading to skeletal instability)

23
Q

How is acute osteomyelitis treated?

A

best guess antibiotics firstly (Fluclox)

unless abscess formation - need surgical drainage

24
Q

What should be done if acute osteomyelitis fails to resolve after first line of antibiotics?

A

second line antiBs

or surgery to gain samples for culture

25
Q

How can chronic osteomyelitis be treated?

A

NOT by antibiotics alone
ALso need surgery to gain deep bone tissue cultures, to remove sequestrum and excise any infected or non viable bone (DEBRIDEMENT)

26
Q

What is a problem with debridement?

A

may result in instability, bone must be stabilized by internal or external fixation

27
Q

What is the advantage of external fixation?

A

bone can be subsequently lengthened if it has been shortened as a result of the debridement

28
Q

What are continued for several weeks after surgery to treat chronic OM?

A

IV antibs

29
Q

Who are at particular risk of osteomyelitis of the spine?

A

poorly controlled diabetics, IV drug users, immunocomp

30
Q

What is the commonest location where in the spine which OM can present?

A

lumbar spine

31
Q

How does a patient present with OM of the spine?

A

insidious onset of back pain which is constant and unremitting

32
Q

What are signs of spinal OM?

A

muscle spasm
spinal tenderness
may have systemic upset

33
Q

Severe cases of spinal OM may have lower motor neurone/cauda equine syndrome below where and upper motor neurone and myelopathy above where?

A

L1

34
Q

What may vertebral collapse lead to in spinal OM?

A

kyphosis
vertebra plana (flat vertebra)
disc space may reduce

35
Q

What should also be considered in spinal OM?

A

endocarditis

36
Q

What treatment is given for spinal OM?

A

high dose IV antibiotics after CT guided biopsy to gain tissue culture
may need for several months
May need surgery - debridement, stabilization, fusion of vertebrae

37
Q

How does septic arthritis present?

A

severely painful, red, hot swollen and tender joint (similar to gout)

38
Q

How do pathogens spread to the joint in septic arthritis?

A

often via the blood or from adjacent tissues

Or from direct penetration e.g. rose thorn, tooth penetration

39
Q

What is the most common cause of septic arthritis?

A

staph aureus

40
Q

In whom is E.coli a cause of septic arthritis?

A

elderly, immunocomp, IV drug users

41
Q

Do bacterial infections cause irreversible or reversible damage to hyaline cartilage in joints?

A

can be irreversible within days

42
Q

What can metaphyseal osteomyelitis lead to?

A

septic arthritis

43
Q

What should be suspected if more than on joint or bone is affected by septic arthritis?

A

endocarditis

44
Q

What should be done for any joint suspected of being septic?

A

aspiration before antibiotics are given

a single dose of antibiotics can lead to a falsely negative gram stain and culture

45
Q

What is the normal treatment for septic arthritis?

A

surgical washout

46
Q

What can act as a very effective culture medium for bacteria to thrive on in soft tissues?

A

haematoma

47
Q

How do bacteria normally enter the operative site during surgery?

A

from patient’s own skin

48
Q

What is there a risk of when a deep infection complicates a fracture fixation?

A

chronic osteomyelitis

non union of fracture

49
Q

Name a bacteria which causes a more low grade infection, most often diagnosed late?

A

staph epidermis and enterococcus

50
Q

What is the treatment for orthopaedic infection?

A

surgery (before antibs)

MSK Pathology (17 decks)

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