Osteomyelitis

Question 1

Define osteomyelitis

Answer 1

Infection of the bone leading to inflammation, necrosis and new bone formation. Can be acute, subacute or chronic.

Causative organisms:
Staphylococcus aureus
Group A Streptococcus

Question 2

Explain the aetiology/risk factors of osteomyelitis

Answer 2

Bacterial infection from indirect inoculation from
skin (e.g. trauma, operative, chronic skin ulcers, haematogenous spread)

Risk Factors
Diabetes
Immunosuppression
IV drug use
Prostheses
Sickle-cell anaemia

Question 3

Summarise the epidemiology of osteomyelitis

Answer 3

Mostly in YOUNG CHILDREN

< 20% of cases are in adults

Question 4

Recognise the presenting symptoms of osteomyelitis

Answer 4

Pain in the affected area
Fever
Malaise
Rigors
History of preceding skin lesion, sore throat, trauma or operation

NOTE: infants may not show localising sign

Question 5

Recognise the signs of osteomyelitis on physical examination

Answer 5

Localised erythema
Tenderness
Swelling
Warmth
Painful/limited movement of affected limb
Seropurulent discharge from an associated wound or ulcer

Question 6

Identify appropriate investigations for osteomyelitis

Answer 6

Bloods
FBC
Blood culture
ESR
CRP

Swabs of wound or discharge

Radiographs

Radioisotope bone scan - shows areas of increased activity