Osteomyelitis ****

Question 1

What are the necrotic areas called?

Pathophysiology:

3 way of getting an infection:

• Haematogenous spread
• Direct inoculation
• Contagious spread

Define all of them

Answer 1

Sequestra

Haematogenous route via nutritional arteries

Direct implantation secondary to trauma or surgery

Spread from infectious focus in contagious soft tissues

Question 2

S+S:

General features?

Why do you have to be mindful of this in DM?

What is important to keep in mind with prosthetic joint infection?

Clinical presentation is HIGHLY VARIABLE

Answer 2

Local inflammation
Pain
Slight effusion of neighbouring joints
Systemic sym

They may be asymptomatic due to neuropathy

The skin on the surface may look absolutely fine

Question 3

Risk factors:

What could allow pathogen entry?

What co-morbidites increases your risk?

Answer 3

Open fracture
Orthopaedic surgery
Surgical prostheses

DM - ulcer

Question 4

Investigations:

Fever is often ABSENT

What bloods would you do? - 2

What is the gold standard for diagnosis?

Does the infection look darker or lighter on XR?

What other imaging can be done for a more definite diagnosis?

Answer 4

FBC - raised WBC
ESR/CRP
Blood cultures

Bone marrow biopsy + culture
Tissue biopsy
Joint aspiration

The dark area in the bone
Soft tissue swelling

CT/MRi

Question 5

Management:

ABs obviously!

Oral or IV

What is done if it severe?

Answer 5

Debridement to drain pus and remove sequestra