Osteomyelitis

Question 1

What is osteomyelitis?

Answer 1

Osteomyelitis is inflammation to the bone and bone marrow, usually caused by bacterial infection

Question 2

What is haematogenous osteomyelitis vs direct penetration?

Answer 2

When a pathogen is carried through the blood and seeded in the bone
vs
Direct contamination of the bone e.g at a fracture site or during an orthopaedic operation

Question 3

What is the most common cause of osteomyelitis?

Answer 3

Staphylococcus aureus

Question 4

What are the risk factors for osteomyelitis?

Answer 4

Open fractures
Orthopaedic operations
Diabetes
Peripheral arterial disease
IV drug use
Immunosuppression
Rheumatoid arthritis
CKD

Question 5

What other organisms can cause osteomyelitis?

Answer 5

Coagulase negative staphylococcus
Streptococcus pneumoniae
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella species

Question 6

What is the clinical presentation of osteomyelitis?

Answer 6

Fever
Pain and tenderness
Erythema
Swelling
Reduced range of movement
Reluctance to weightbear

Question 7

What investigations are used in the diagnosis of osteomyelitis?

Answer 7

FBC - raised WBC
Raised CRP and ESR
Blood cultures
Wound swab
X-ray of affected area
Bone biopsy

Question 8

What are the XR findings in osteomyelitis?

Answer 8

Osteopenia
Bone destruction
Periosteal reaction
Cortical breaches

Question 9

What is the management of acute osteomyelitis?

Answer 9

1st line - IV flucloxacillin
- If suspected MRSA - vancomycin, teicoplanin or linezolid
- If suspected pseudomonas - piperacillin/tazobactam

2nd line - surgical debridement