Osteomyelitis

Question 1

Osteomyelitis types

Answer 1

Acute haematogeneous
2° to contiguous local infection
Direct inoculation from trauma

Question 2

Osteomyelitis risk factors

Answer 2

Diabetes/vascular disease
Impaired immunity
Sickle cell
Prosthesis
Open fracture

Question 3

Osteomyelitis presentation

Answer 3

Gradual onset pain
Unwillingness to move over a few days
Tenderness/warmth/erythema/effusion
Systemic infection signs

Question 4

Osteomyelitis diagnosis

Answer 4

ESR/CRP, WCC inc
Blood culture in haematogeneous
Bone biopsy + culture is gold standard
MRI may show bone marrow oedema

Question 5

Osteomyelitis treatment

Answer 5

6 wks antibiotics (fluclox IV as s. aureus most common)
Vancomycin 1g/12h + cefotaxime 1g/12h IVI
Alternatives are fusidic acid + clindamycin
Ciprofloxacin 500mg/8-12h PO good for pseudomonas

Question 6

Osteomyelitis complications

Answer 6

Septic arthritis
Fractures
Deformity
Chronic osteomyelitis

Question 7

What is chronic osteomyelitis

Answer 7

Pain, fever, infected dead bone and sinus tract development with long remissions

Question 8

Chronic osteomyelitis risk factors

Answer 8

Osteomyelitis with vascular insufficiency + non-healing tissue overlying bony prominences
Diabetic ulcers

Question 9

Chronic osteomyelitis treatment

Answer 9

Excision of sequestra (infected dead bone)
Skeletal stabilisation
Dead-space managment
Antibiotics for >12 wks