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MSK- Surgery and Trauma (CORTEXT 5 and 6) > Orthopaedic Infections > Flashcards

Orthopaedic Infections Flashcards

1
Q

What type of organisms usually cause osteomyelitis?

A

Mostly bacteria, sometimes fungi

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2
Q

How can organisms get into bone directly?

A

From penetrating trauma or surgery

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3
Q

How can organisms get into bone indirectly?

A

Haematogenous spread from infection at a distant site

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4
Q

Which patients are at increased risk of osteomyelitis?

A

Immunocompromised, chronic disease, elderly and young

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5
Q

What is osteolysis?

A

An inflammatory response in bone which leads to resorption

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6
Q

Once a bone is infected, enzymes from leukocytes cause local osteolysis which causes what?

A

Pus to form, which impairs blood flow and makes the infection difficult to eradicate

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7
Q

What is a sequestrum?

A

A dead segment of bone

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8
Q

Once a sequestrum breaks off in osteomyelitis, how does this alter the treatment?

A

Antibiotics alone will no longer cure the infection

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9
Q

What is an involucrum?

A

New bone forming around an area of necrosis

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10
Q

Acute osteomyelitis, in the absence of recent surgery, usually occurs in who?

A

Children or immunocompromised adults

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11
Q

In children, the sluggish metaphyseal blood flow leads to the accumulation of bacteria and infection spreading towards what part of the bone?

A

Epiphysis

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12
Q

In neonates and infants, certain metaphyses are intra-articular, what is the significance of this?

A

Infection of bone can spread into the joint causing co-existant septic arthritis

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13
Q

Infants have a loosely applied periosteum- what is the significance of this?

A

An abscess can extend widely

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14
Q

What will the onset be of subacute osteomyelitis in children?

A

Insidious

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15
Q

Subacute osteomyelitis in children may lead to the formation of a Brodie’s abscess- what is this?

A

The bone reacts to an abscess by walling it off with a thin rim of sclerotic bone

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16
Q

In adults, in which skeleton does chronic osteomyelitis tend to be?

A

Axial (spine and pelvis)

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17
Q

Chronic osteomyelitis in the axial skeleton of adults usually comes from where?

A

Haematogenous spread from pulmonary or urinary infections, or discitis

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18
Q

Why does chronic osteomyelitis not present earlier?

A

It gets suppressed by antibiotics and can lay dormant for many years before reactivating

19
Q

What are some symptoms that reactivation of chronic osteomyelitis may cause?

A

Localised pain, inflammation, systemic upset, discharge

20
Q

What lung infection is known for causing chronic osteomyelitis, especially of the spine?

A

TB

21
Q

What is the most common organism causing chronic osteomyelitis?

A

Staph Aureus

22
Q

What organism causing osteomyelitis is unique to patients with sickle cell anaemia?

A

Salmonella

23
Q

What does it mean if osteomyelitis is classed as ‘diffuse’?

A

A segment of bone is infected, causing skeletal instability

24
Q

What is the treatment for acute osteomyelitis?

A

Best guess antibiotics IV, unless there is an abscess which requires surgical drainage

25
Q

If an acute osteomyelitis fails to settle after initial treatment, what should be done?

A

Second line antibiotics or surgery to gain samples/remove infected bone/washout

26
Q

What are the purposes of surgery fro chronic osteomyelitis?

A

Gain deep cultures / Remove sequestrum / Debridement

27
Q

What is the complication of surgical debridement of bone?

A

Instability

28
Q

If surgical debridement of a bone results in instability, what needs to be done?

A

Internal or external fixation

29
Q

What is the advantage of using external fixation for instability following bone debridement?

A

The leg can be subsequently lengthened

30
Q

Which populations are at increased risk of osteomyelitis of the spine?

A

Poorly controlled diabetics, IV drug users, immunocompromised patients

31
Q

If osteomyelitis occurs in the spine, which area does it normally affect?

A

Lumbar

32
Q

How will patients with osteomyelitis of the spine present?

A

Insidious onset of back pain which is constant and unremitting

33
Q

Apart from back pain, what are some other symptoms that people with osteomyelitis of the spine might present with?

A

Paraspinal muscle spasm, fever, systemic upset

34
Q

What tests should you do for osteomyelitis of the spine?

A

MRI and blood cultures

35
Q

If a patient has osteomyelitis, you should consider which other infection may also be present? How would you test for this?

A

Endocarditis- ECHO

36
Q

How is a tissue culture obtained for osteomyelitis of the back?

A

CT guided biopsy

37
Q

What is the treatment for osteomyelitis of the spine?

A

High dose IV antibiotics (possibly for months)

38
Q

If surgery is required for osteomyelitis of the spine, what can be done?

A

Debridement, stabilisation and fusion of adjacent vertebrae

39
Q

What aspect of soft tissue injuries can act as a very effective culture medium for bacteria to thrive on?

A

Haematoma

40
Q

What is the concern when a deep infection complicates a prosthetic joint replacement?

A

Development of chronic infection with pain, poor function sepsis, discharge and loosening

41
Q

What is the concern when a deep infection complicates a fracture fixation or stabilisation?

A

Chronic osteomyelitis and non-union of the fracture

42
Q

What are some common virulent organisms which produce an early prosthetic infection?

A

Staph aureus, gram - bacilli including coliforms

43
Q

What are some organisms which may cause a low grade infection of a prosthetic joint and can present up to a year after surgery?

A

Staph epidermidis, enterococcus

MSK- Surgery and Trauma (CORTEXT 5 and 6) (13 decks)

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