Osteomyelitis and osteoporosis

Question 1

types of osteomyelitis

Answer 1

Suppurative- infection, has pus

Non-supurative, tuberculosis

Question 2

Osteomyelitis general information

Answer 2

90% caused staphyloccoccus aureus
If it spreads into joint: septic arthritis
2-12 years old
esentially skeletal sepsis

Question 3

Radiological hallmark features of osteomyelitis

Answer 3

Moth eaten metaphysis
laminated periosteal response
involucrum
Sequestrum

Question 4

Aeitology of suppurative osteomyelitis

Answer 4

1. haematogenous spread
2. spread from continguous source of infection
3. direct (puncturing wounds)
4. Post operative

Question 5

Location of osteomyelitis

Answer 5

metaphyseal region usually, in long bones
soft tissues involved before bones
spine in children, discs in adults

Question 6

Treatment osteomyelitis

Answer 6

antibiotics, surgical draingage, debridements

Question 7

Clinical presentation of osteomyelitis

Answer 7

INFANTS: fever, chills, pain and swelling, loss of limb function, acute process
ADULT- chronic, insiduous, fever, malaise, pain,
SPINAL- URTI hx, local tenderness, decreased ROM,

Question 8

Infant spread of OM

Answer 8

infection may travel into physis becasue of vascular connection remains up until 8ish months

Question 9

Children spread of OM

Answer 9

between 1 year to the time physis fuses. COntained to metaphysis because seperate blood supply

Question 10

Adult spread of OM

Answer 10

vessels penetrate to physis therefore infection can spread from bone to joint

Question 11

Pathophysiology of OM- initial

Answer 11

infection organism in medulla- vascualr and cellular reaction= odema
oedema leads to intramedullary pressure, results in infarction marrow fat, bone and haematopoeitic tissue
active hyperaemia around infarction with osteoclastic activity= osteoporosis
infection then penetrates endosteum, eneter haversian and luncae systems into periosteal space. Kids dont have many sharpeys fibres so periosteum is stripped or if adult- periostiotitis

Question 12

Sequestrum in OM

Answer 12

necrotic tissue sitting around the bone. Means to ‘set apart’. Dead bone from the medulla and cortex set apart from the normal bone.
as pus forms it lifts the periosteum for new bone proliferation

Question 13

Involucrum in OM

Answer 13

Walling off to contain infection- perisoteal new bone is tthe bodys way of walling off the infection. bony collar.

Question 14

Cloaca in OM

Answer 14

“sewer”- a defect in the involucrum which inflammatory products drain. seen in chronic and antibiotic resistant osteomyelies.

Question 15

Marojins ulcer in OM

Answer 15

a complication of the cloaca- when the draining sinus develops a squamous cell carcinoma in the channel.

Question 16

Brodies Abcsess clinical features

Answer 16

a walled off geopgrahic lesion
localised aborted form of osteomyelitis
similar to osteoid osteoma 
limb pain, worse at night, releived by aspirin
hx recent infection
metaphysis of long bone

Question 17

Pathology of Brodies Abscee

Answer 17

in bone cavity, wall of inflammatory granulation tissue

adjacent spogy bone becomes sclerotic

Question 18

Radiological findingsg of Brodies Abscess

Answer 18

oval lytic lesion with reactive sclerosis
moth eaten or permeative
bigger holes than osteoid osteoma but cannot tell apar!!

Question 19

Latent period of Brodies Abscess radiology

Answer 19

No signs on x-ray
infection in extremity last 10 days
spinal infection 21 days
Nuclear bone scan postivie in a few hours

Question 20

Soft tissue signs of Brodies Abscess radiolgoy

Answer 20

earliest sign, within 3 days of infection
deep ST swelling
elevation of fat pads
detect ST mass

Question 21

Bone destruction phase of Brodies abscess

Answer 21

Moth eaten or permeative patterns that spread from metaphysis to other regionds.
overtime, osteopoenia and lesions.

Question 22

Periosteal response Brodies Abscess

Answer 22

Laminated pattern

codmans triangle

Question 23

Spinal presentations of BA

Answer 23

children- adolescents still have channgesl to disc therefore disc infection, causes narrowing, end plate destruction, lytic destruction
adults- discs are avascular, therefore infection in anterior endplate, lucency and irregularity beneath endplate. vertebral destruction and collapse.

Question 24

Osteoporosis clinical presentation

Answer 24

asymptompatic until pathological fracture, shortened stture, increased kyphosis and spinal regiditiy
most commonly presents in neck of femur, L3, pubic rami

Question 25

Radiological appearance of osteporosos

Answer 25

increased lucency, cortical thinning, widepsread, no trabecular stress lines
pancake fracture, wedge fracture, biconcave

Question 26

DEXA scores

Answer 26

Osteopoenia, T score of -1 to -2.5

Osteoporosis, T score of -2.5 >