Osteomyelitis

Question 1

What is osteomyelitis?

Answer 1

Infection of the bone.

Most commonly distal femur and proximal tibia, but any bone may be affected.

Usually spread from the blood, more likely if there is a foreign body in the leg.

Question 2

What are the common causative organisms?

Answer 2

Staph aureus.

Can also be caused by:

• Strep
• HIB
• Tb

Question 3

How will a child with osteomyelitis present?

Answer 3

A febrile child with:

• Severe pain and tenderness in affected limb
• Immobile limb (pseudoparesis)
• Swelling and erythema

May be much more insidious onset in infants

Question 4

What investigations should be carried out in suspected osteomyelistis?

Answer 4

Obs.

Bloods:

• Cultures
• FBC
• CRP/ESR

Imaging:

• Xray
• MRI

Initially may not be able to see any changes with an X-ray

Question 5

How should osteomyelitis be managed?

Answer 5

IV antibiotics for a long period should only be stepped down to oral with a marked improvement.

Supportive measures also:

• Analgesia
• Fluids if necessary

Question 6

What is sub acute osteomyelitis?

Answer 6

Osteomyelitis which presents much more insidiously.

Symptoms are much milder and it does not cause a systemic response.

Symptoms often include:

• Moderate pain often worse at night
• Erythema and some swelling
• Minimal impact on function

Question 7

What is chronic osteomyelitis?

Answer 7

If acute osteomyelitis is not treated it can progress to chronic osteomyelitis, producing permanent damage.

It can also be caused by tertiary syphillis.

Symptoms include:

• bone pain, swelling and erythema
• persistent fatigue
• pus draining from a sinus
• excessive sweating and chills.

Question 8

What are the potential complications of osteomyelitis?

Answer 8

Chronic osteomyelitis
Sepsis and death

Bone destruction causing deformity
Bone destruction may lead to poor vascularisation leading to necrosis which may result in amputation.