PAEDIATRIC ORTHOPAEDIC EMERGENCIES SEPSIS Flashcards
What is osteomyelitis?
Inflammation of bone
Osteomyelitis can arise from infections that reach the bone through the bloodstream or from nearby tissue.
What is arthritis?
Inflammation of a joint
Arthritis can result from various causes, including infections, autoimmune diseases, and wear and tear.
What age group is most commonly affected by acute osteomyelitis?
Usually the first decade of life
Why is acute osteomyelitis more common in lower socio-economic groups?
Due to factors like limited access to healthcare and higher rates of infections
What conditions can lead to immune compromise in acute osteomyelitis?
Diabetes, renal disease, HIV
Which gender is more commonly affected by acute osteomyelitis?
Boys
How has the mortality rate of acute osteomyelitis changed with antimicrobial therapy?
Decreased from 50% to less than 1%
What is the first step in the pathogenesis of acute osteomyelitis?
Metaphysis with venous sinusoids, slow blood flow, no cell lining
What is transient bacteraemia in the context of osteomyelitis?
Bacteria entering the bloodstream from skin, concurrent infection, or teeth
What effect does oedema have in acute osteomyelitis?
Increases tissue tension and can cause small infarcts (death of bone)
What are the consequences of pus formation in acute osteomyelitis?
Can lead to septicaemia, infarction, and abscess in soft tissues
Which bacterium is the most common cause of osteomyelitis in all age groups?
Staphylococcus aureus
Which bacterium is commonly associated with osteomyelitis in immune-compromised individuals?
Streptococcus
What clinical features are associated with acute osteomyelitis?
History of trauma, pain, fever, limp, reluctance to bear weight, pseudo-paralysis, metaphyseal tenderness
What lab investigations are commonly performed for acute osteomyelitis?
WCC ↑, ESR ↑, CRP ↑, blood cultures, HIV, U+E
What do X-rays show in the early stage of osteomyelitis?
Initially normal (<10 days)
What is a differential diagnosis for acute osteomyelitis?
Trauma, tumour (leukaemia, Ewing’s sarcoma), septic arthritis, bone infarction
What is the first step in the management of acute osteomyelitis?
Identify organism – blood cultures
What type of antibiotics is used for all ages in acute osteomyelitis?
Cloxacillin
What is a potential complication of acute osteomyelitis?
Chronic osteomyelitis
What is acute septic arthritis?
Infection from the bloodstream or secondary infection from adjacent bone
What is the primary pathological feature of acute septic arthritis?
Synovitis with fluid rich in polymorphs in the joint
What are the clinical features of acute septic arthritis?
Pain, limp, pyrexia, tense swelling of joint, decreased movement
What do X-rays reveal in acute septic arthritis?
Widened joint space (sometimes)
Widening can occur due to pus collection in the joint.
What is a differential diagnosis for acute septic arthritis?
Trauma, tumour, tuberculosis, acute rheumatic fever, rheumatoid arthritis, osteomyelitis
What is the treatment approach for acute septic arthritis?
Same as acute osteomyelitis but with arthrotomy (open drainage of the joint)
How long should antibiotics be administered for acute septic arthritis?
4 weeks
