Miscellaneous

Question 1

Causes of pathological fractures

Answer 1

-Metastatic tumours
=Breast
=Lung
=Thyroid
=Renal
=Prostate

-Bone disease
=Osteogenesis imperfecta
=Osteoporosis
=Metabolic bone disease
=Paget’s Disease

-Local benign conditions
=Chronic osteomyelitis
=Solitary bone cyst

-Primary malignant tumours
=Chondrosarcoma
=Osteosarcoma
=Ewing’s tumour

Question 2

Features of bone metastases

Answer 2

-Pathological fractures
-Hypercalcaemia
-Raised ALP
-Bone pain

Question 3

Overview of cellulitis

Answer 3

-Bacterial infection that affects the dermis and the deeper subcutaneous tissues.
-Streptococcus pyogenes or less commonly Staphylococcus aureus.

-Features:
=commonly occurs on the shins
=usually unilateral - bilateral cellulitis is rare and suggests an alterative diagnosis
erythema
=generally reasonably well-defined margins but some cases may present with diffuse erythema
=blisters and bullae may be seen with more severe disease
=swelling
=systemic upset
=fever
=malaise
=nausea

-Diagnosis: clinical, bloods and cultures
=Eron classification (1-4)
=1: no systemic
=2: unwell/ comorbidities
=3: significant (limb-threatening)
=4: sepsis/ life threatening

-Management:
=1: oral flucloxacillin/ clarithromycin/ doxy
=3/4: admit, IV co-amoxiclav, clindamycin, cefuroxime, ceftriaxone

Question 4

Overview of osteomyelitis

Answer 4

-Haematogenous osteomyelitis
=Results from bacteraemia, is usually monomicrobial, most common form in children
=Vertebral osteomyelitis is the most common form of haematogenous osteomyelitis in adults
=Risk factors include: sickle cell anaemia, intravenous drug user, immunosuppression due to either medication or HIV, infective endocarditis

-Non-haematogenous osteomyelitis:
results from the contiguous spread of infection from adjacent soft tissues to the bone or from direct injury/trauma to bone
is often polymicrobial
=most common form in adults
=risk factors include: diabetic foot ulcers/pressure sores, diabetes mellitus, peripheral arterial disease

-Microbiology
=Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate

-Investigations
=MRI is the imaging modality of choice, with a sensitivity of 90-100%

-Management
=flucloxacillin for 6 weeks
=clindamycin if penicillin-allergic