Osteomyelitis Flashcards

1
Q

What is osteomyelitis?

A

Infection of bone marrow

Can be due to haematological spread or direct invasion from trauma

Can be acute or chronic

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2
Q

What is the difference between acute and chronic osteomyelitis?

A

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
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3
Q

What are common causative organisms?

A

Neonates- E.coli
<4 Hib
All ages= staph aureus, strep pyogenes, strep pneumoniae

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4
Q

What is the pathophysiology?

A

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

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5
Q

What are symptoms of acute osteomyeltis?

A

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

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6
Q

What are symptoms of chronic osteomyelitis?

A
History of osteomyelitis
Recurrent pain, fever, redness and swelling
Excoriation of surrounding skin
Foul and purulent discharge
Thickened overlying tissue
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7
Q

What investigations are needed?

A

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

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8
Q

What are differentials to osteomyelitis?

A
Cellulitis
Necrotising fasciitis
SA if near joint
Crystal associated arthritis if near joint
Compartment syndrome if recent trauma
Rheumatic fever
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9
Q

What is the management of osteomyelitis?

A

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
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10
Q

What is viral arthropathy?

A

Arthritis caused by viral infection
Occurs in prodromal phase with associated rash, fever, conjunctivitis and malaise

Symmetrical and non destructive

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