Osteomyelitis

Question 1

What is osteomyelitis?
What bacteria is commonly associated?
Which sites are affected in children compared with adults?

Answer 1

Infection of the bone and bone marrow, typically in the metaphysis of long bones 7

Staph aureus

Children= long bones
Adults (50-60s)= vertebrae

Question 2

What are the 2 different types of osteomyelitis and how do they present?

Answer 2

Acute

• more rapid onset of symptoms
• acutely unwell child

Chronic
-slow development of symptoms

Refusing to beat weight on limb 
Pain 
Swelling 
Tenderness 
Erythema 
Afebrile or low grade fever 
NOTE: high fever might be present in acute if spread to joint and causing septic arthritis

Question 3

What are risk factors for developing?

Answer 3

Open bone fracture 
Orthopaedic surgery 
Immunocompromised
Sickle cell anaemia 
HIV 
Tuberculosis

Question 4

What are the 3 classifications and how are they classified?

Answer 4

Contiguous spread
-spread of soft tissue infection

Direct inoculation
-secondary to trauma or surgery

Haematogenous
-bacterial emboli in bone

Question 5

What investigations are bone is osteomyelitis is susepcted?

Answer 5

FBC +CRP

Blood culture= causative organism

X-ray
-can be normal in early disease i.e. cannot be used to exclude osteomyelitis if there is clinical suspicion

USS for biopsy to remove biofilm

MRI

CT-> aids planning of surgery

Bone scan

Bone marrow aspirate

SPECT scan
-nuclear medicine which helps to identify active infection inside chronic osteomyelitis

Question 6

How is it managed?
What are the different types of antibiotics used?
What are the different components of surgical management?

Answer 6

Prolonged course of antibiotics

• beta-lactams i.e. Flucloxacillin
• Lincosamides i.e. clindamycin

In chronic infection:

• fluoroquinolines i.e. ciprofloxacin + Moxifloxacin
• Linezolid/fucific acid/rifampicin

May need surgery-

• drainage or debridement
• dead space management
• stabilisation
• wound closure
• rehab
• bone transport i.e. Ilizarov bone transport (osteotomy and then distraction osteogenesis with tightening of frame over time to bring bone ends together)

Question 7

What are the potential signs of osteomyelitis on xray?

Answer 7

Periosteal reaction
Localised osteopenia
Destruction

Question 8

What is Pott’s disease?

Answer 8

Form of osteomyelitis which occurs due to TB infection of vertebrae effecting the lowet spine

Leads to arthritis of intervertebral joints meaning to intervertebral disc cannot regenerate
-> leads to COLLAPSE

Question 9

What is chronic osteomyelitis characterised by?

Answer 9

Reactive bone (involucrum)

Sinuses
-where infective bone penetrates out of bone and reaches skin surface

Sequestrum
-trapped necrotic bone

Biofilm

Question 10

What are the 2 components of Cierny and Mader classification of osteomyelitis?

Answer 10

Anatomical

• medullary
• superficial
• localised
• diffuse

Physiological
-type A-C based on host factors