Osteomyelitis

Question 1

what is osteomyelitis (RF, Sx)

Answer 1

infection of the metaphysis of long bones -usually distal femur/proximal tibia
growth plates prevents spreading
often from
heamatogenous spread -from Staph aureus usually
<5y/o

sx- most chronic onset and less severe than septic arthiritis (week rather than day)
fever, acute (week) onset limb pain, 
immobile limb, 
swollen skin, tender, erythematous
signs of sepsis (mottled, tired, etc)

Question 2

Ix and mx of osteomyelitis

Answer 2

sepctic screen -
Blood cultures and FBC (wCC and CRP up)
Joint aspirate and MCS-turbid usualy
XR => MRI to show soft tissue
Xray normal until later in disease (then osteopenia)
USS can be used

Mx -
acute osteomyelitis - high dose empirical -> narrow spectrum for 2-4weeks once sennsitivities back

1st -flucloxicillin
2nd line (pen allergy)-clindamycin
If MRSA -vancomycin

take cultures before IV abx, IV to oral when CRP normal
surgical debridement can be used if dead bone/biofilm

chronic osteo -
clinical assessment and staging -optimise co-morbidities
Surgical debridement
IV Abx
rehab