Osteomyelitis

Question 1

What is the epid for acute osteomyelitis?

Answer 1

1. unwell child with limp

2. immunosuppressed patient

Question 2

What is the epid for chronic osteomyelitis?

Answer 2

adults with history of open fracture, previous orthopaedic surgery or discharging sinus

Question 3

When would you consider native vertebral osteomyelitis?

Answer 3

osteomyelitis in patient with new back pain and systemic symptoms

Question 4

What is the most common pathogen in osteomyelitis?

Answer 4

Staph aureus (+ group A strep)

Question 5

What are RF for osteomyelitis?

Answer 5

1. Previous osteomyelitis
2. Penetrating injury
3. IV drug misuse
4. HIV
5. Recent surgery

Question 6

What are RF for children osteomyelitis?

Answer 6

1. Upper resp tract
2. Varicella infection
3. No Hib vaccination

Question 7

What are symptoms and signs for osteomyelitis?

Answer 7

1. Limp or reluctance to weight bear
2. Non-specific pain at site of infection
3. Malaise and fatigue
4. Local back pain with systemic symptoms
5. Local inflammation, tenderness, erythema or swelling

Question 8

What are possible DDx for osteomyelitis?

Answer 8

1. Septic arthritis
2. Juvenile idiopathic arthritis
3. Transient synovitis
4. Reactie arthritis
5. Cellulitis

Question 9

What blood do you order and what would they be in osteomyelitis?

Answer 9

1. FBC: WCC rasied
2. ESR: raised
3. CRP: raised
4. Blood culture: can show which antibiotic to use

Question 10

What imaging is used for osteomyelitis?

Answer 10

plain X rays/CT or MRI of affected area

Question 11

What is the management of osteomyelitis?

Answer 11

CHECK SEPSIS

Antibiotics and surgery if correct

Question 12

What are possible complications of osteomyelitis?

Answer 12

1. Drug reaction
2. Amputation
3. Fracture
4. Joint stiffness

Question 13

What are 3 ways you can get infection of the bone?

Answer 13

1. Haemotogenous spread
2. Continguous spread
3. Direct incoulation

Question 14

What are haemotogenous spread ways you can get osteomyelitis?

Answer 14

1. IVDU
2. Immunosuppresion
3. Diabetes
4. Sickle cell

Question 15

What are contiguous spread ways you can get osteomyelitis?

Answer 15

1. Cellulitis

2. Localised infection

Question 16

What are direct inoculation ways you can get osteomyelitis?

Answer 16

1. Penetrating injury
2. Ulcers
3. Surgery

Question 17

How does the type of infection you get vary with age?

Answer 17

1. Common in young children & affects the long bones

2. Adults, much more common in the vertebrae e.g., Pott’s disease (TB).

Question 18

What is the general patho of osteomytelitis?

Answer 18

1. Leading to inflammation, necrosis and new bone formation

2. Acute, subacute or chronic (>6 weeks) subtype

Question 19

What is another key investigation to take for osteomyelitis?

Answer 19

Bone culture
(+ blood culture/ wound swabs)
Causative organism identified

Question 20

What would XR or MRI of affected area show?

Answer 20

1. No changes in first 2 weeks

2. Darkening (infected areas), periosteal thickening

Question 21

What support is given for osteomyelitis?

Answer 21

Immobilisation and analgesia

Question 22

What high dose IV abx is used for osteomyelitis?

Answer 22

1. Empirical Abx then adapt to cultured organism & lab sensitivities
2. 2-4 weeks

Question 23

What is indication for surgical debridement?

Answer 23

biofilm, dead bone