Osteomyelitis Flashcards
What is osteomyelitis?
Infection of bone marrow
Can be due to haematological spread or direct invasion from trauma
Can be acute or chronic
What is the difference between acute and chronic osteomyelitis?
Acute
-Common target site is metaphyseal plates of long bones in young children or spine of immunosuppressed adults
Chronic
- prolonged inflammation of the bone marrow
- most commonly due to open fractures or surgery
What are common causative organisms?
Neonates- E.coli
<4 Hib
All ages= staph aureus, strep pyogenes, strep pneumoniae
What is the pathophysiology?
Inflammatory response leading to increased intraosseous pressure and pain
Pus then appears in the main shaft of the long bone and forces its way to the surface forming a subperiosteal abscess which can form a sinus and drain at the surface
The compromised blood flow then leads to necrosis
Osteoblasts stimulate new bone formation and the bone will heal with abx and controlled intraosseous pressure
What are symptoms of acute osteomyeltis?
Continuous throbbing pain worse at night
Fever
Tiredness
Localised erythema, warmth and oedema- late sign
Sepsis
Neonates
- FTT
- Drowsy
- Irritable
Children- cannot touch or move adjacent joint
Adult backache
What are symptoms of chronic osteomyelitis?
History of osteomyelitis Recurrent pain, fever, redness and swelling Excoriation of surrounding skin Foul and purulent discharge Thickened overlying tissue
What investigations are needed?
Bloods
- WCC, CRP= raised
- U&Es, LFTs= look for abnormalities
- Blood cultures= ?sepsis
- Uric acid if near joint
Septic screen
XR
- normal/soft tissue swelling in 1st 10 days
- by 2 weeks= decreased bone density and new bone formation
MRI= gold standard
What are differentials to osteomyelitis?
Cellulitis Necrotising fasciitis SA if near joint Crystal associated arthritis if near joint Compartment syndrome if recent trauma Rheumatic fever
What is the management of osteomyelitis?
Acute
- urgent orthopaedic referral
- A-E
- Analgesia
- IV fluids
- IV abx for 3 months
- -adults= fluclox, clindamycin
- -Paeds= fluclox, clindamycin, cefotaxime
- Supportive structures e.g. splints
Chronic
- Admit
- IV abx to prevent spread and control flare
- appropriate dressing
- surgery= if significant symptoms or clear evidence of sequestrum
What is viral arthropathy?
Arthritis caused by viral infection
Occurs in prodromal phase with associated rash, fever, conjunctivitis and malaise
Symmetrical and non destructive