5.1. Bone and Soft Tissue Infection - Acute (and Subacute) Osteomyelitis Flashcards Preview

3rd Year - MSK Diseases > 5.1. Bone and Soft Tissue Infection - Acute (and Subacute) Osteomyelitis > Flashcards

Flashcards in 5.1. Bone and Soft Tissue Infection - Acute (and Subacute) Osteomyelitis Deck (35):
1

What are the 4 categories of Osteomyelitis?

1. Acute (Subacute) Osteomyelitis
2. Chronic Osteomyelitis
3. Specific Osteomyelitis
4. Non-Specifc Osteomyelitis

2

What are the Risk Factors for having Haematologenous spread of infection, causing Acute Osteomyelitis?

1. Children and Elderly
2. Boys > Girls
3. History of Trauma
4. Other Diseases (e.g. Diabetes, Rheumatoid Arthritis, Immune compromise, Long-term Steroid Treatment, Sickle Cell Anaemia)

3

How does Haematologenous spread, causing Acute Osteomyelitis occur?

Local spread from Contiguous Site of infection:
1. Trauma (open fracture)
2. Bone Surgery (ORIF)
3. Joint Replacement

4

What are the most common sources of infection, causing Acute Osteomyelitis, in infants?

Infected umbilical cord

5

What are the most common sources of infection, causing Acute Osteomyelitis, in children?

1. Boils (Furunculosis)
2. Tonsilitis
3. Skin abrasions

6

What are the most common sources of infection, causing Acute Osteomyelitis, in adults?

1. Urinary Tract Infections
2. Arterial Line

7

What are the most common infective organisms, causing Acute Osteomyelitis, in Infants (<1 year)?

1. Staph. Aureus
2. Group B Streptococci
3. E. Coli

8

What are the most common infective organisms, causing Acute Osteomyelitis, in Older Children?

1. Staph. Aureus
2. Strep Pyogenes
3. Haemophilus Influenzae

9

What are the most common infective organisms, causing Acute Osteomyelitis, in Adults?

1. Staph. Aureus
2. Coagulase Negative Staphylococci
3. Propionibacterium spp
4. Streptococcus Pyogenes
5. Mycobacterium Tuberculosis
6. Pseudomonas Aeroginosa

10

What type of Organism is likely to cause Acute Osteomyelitis, from a Diabetic Foot patient?

Mixed infection including Anaerobes

11

What type of Organism is likely to cause Acute Osteomyelitis, from a Pressure Sore patient?

Mixed infection

12

What type of Organism is likely to cause Acute Osteomyelitis, from a Vertebral Osteomyelitis patient?

1. Staph. Aureus
2. Tuberculosis

13

What type of Organism is likely to cause Acute Osteomyelitis, from a Sternal Osteomyelitis patient?

Coagulase Negative Staphylococci (post-cardiac surgery)

14

What type of Organism is likely to cause Acute Osteomyelitis, from a Sickle-Cell Anaemia patient?

Salmonella Spp

15

What type of Organism is likely to cause Acute Osteomyelitis, from a Sexually Transmitted Disease patient?

Gonococcus

16

What is the pathology of Acute Osteomyelitis?

1. Trauma causes acute inflammation and vascular stasis
2. Pus forms and Bone reformation occurs
3. If infection gets into the bone during this time - granulation tissue "walls off" the diseased bone tissue (sequestrum)
4. Bacterial proliferation results in further destruction, and abscess formation in the bone

17

What are the clinical features of Acute Osteomyelitis in an infant?

1. Minimal signs / may be very ill
2. Failure to thrive
3. Drowsy / Irritable
4. Metaphyseal tenderness / swelling
5. Decreased Range of Movements + positional change

18

What are the clinical features of Acute Osteomyelitis in a Child?

1. Severe pain - reluctance to move / not weight bearing
2. Fever (swinging Pyrexia)
3. Tachycardia
4. Malaise (Fatigue, Nausea, Vomiting)
5. Toxaemia

19

What are the clinical features of Primary Acute Osteomyelitis in an Adult?

This is seen commonly in the Thoracolumbar Spine:
1. Fever
2. Backache
3. History of UTI or Urological procedure
4. Old
5. Diabetic / Immunocompromised

20

What are the clinical features of Secondary Acute Osteomyelitis in a Adult?

This is more common the Primary Osetomyelitis - often seen after:
1. An open fracture
2. Surgery
Note - this often contains a mixture of organisms

21

What Clinical (Blood) Investigations are done to diagnose Acute Osteomyelitis?

1. Full Blood Count + Diff. WBC
2. Inflammatory markers - ESR + CRP
3. 3 x Blood Cultures
4. Urea & Electrolytes

22

What Radiological Investigations are done to diagnose Acute Osteomyelitis?

1. X-Ray
2. Ultrasound
3. Aspiration
4. Isotope Bone Scan
5. Labelled White Cell Scan
6. MRI

23

What is found on an X-Ray of a suspected Acute Osteomyelitis patient?

1. It appears normal in the first 10-14 days
2. Late Metaphysial Destruction
3. Late Medullary Changes - Lytic Areas
4. Late Osteonecrosis - Sequestrum
5. Late Periosteal New Bone - Involucrum

24

How is a Microbiological diagnosis of Acute Osteomyelitis arrived at?

1. Blood Cultures
2. Bone Biopsy
3. Tissue Swabs from up to 5 sites around an implant at debridement in prosthetic infection

25

What is the differential diagnosis for Acute Osteomyelitis?

1. Cellulitis
2. Eryipelas
3. Necrotising Fasciitis
4. Gas Gangrene
5. Toxic Shock Syndrome
6. Acute Septic Arthritis
7. Trauma
8. Acute Inflammatory Arthritis
9. Transient Synovitis

26

What is the treatment for Acute Osteomyelitis?

1. Analgesia
2. Rehydration Therapy
3. Rest and Splintage
4. I.V. / Oral Antibiotics for 4-6 weeks (Flucloxacillin + Benzylpenicillin until know more specifics)
5. Surgery

27

What are the indications for surgery in Acute Osteomyelitis?

1. Abscess drainage
2. Debridement of Dead / Infected / Contaminated Tissue

28

What are the complications of Acute Osteomyelitis?

1. Septicemia, death
2. Metastatic Infection
3. Pathological Fracture
4. Septic Arthritis
5. Altered Bone Growth
6. Chronic Osteomyelitis

29

When does Subacute Osteomyelitis occur?

1. Increased Host Resistance
2. Lowered Bacterial Virulence
2. Antibiotic Usage

30

What are the Clinical Features of Subacute Osteomyelitis?

1. Long history (weeks-months)
2. Variable Pain / Limp
3. Local Swelling / Warmth
4. Local Tenderness

31

What is the Differential Diagnosis for Subacute Osteomyelitis?

1. Tumour (Ewing;s Sarcoma, Osteoid Osteoma)
2. Tuberculosis

32

What is the name of the Abscess which forms during Subacute Osteomyelitis?

Brodie's Abscess - A well defined cavity in Cancellous Bone

33

What are the Clinical Features of Subacute Osteomyelitis?

1. Painful Limp
2. No systemic Features
3. Most commonly seen in older children

34

What is seen on Radiographical Imaging, when Subacute Osteomyelitis is present?

Luency in a Long Bone Metaphysis

35

What is the treatment of Subacute Osteomyelitis?

1. Prolonged course of Antibiotics
2. Surgery - Curettage

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