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MSK > Infection in Bones and Joints > Flashcards

Infection in Bones and Joints Flashcards

1
Q

Acute osteomyelitis

A
  • new infection of bone
  • mostly children
  • boys > girls
  • history of trauma (minor)
  • other disease
    - diabetes, rheumatoid arthritis, immune compromised, long-term steroid treatment, sickle cell
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2
Q

Acute osteomyelitis-source of infection

A
  • haematogenous spread – children and elderly
  • local spread from contiguous site of infection – trauma (open fracture), bone surgery (ORIF), joint replacement
  • secondary to vascular insufficiency
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3
Q

Acute osteomyelitis-organisms in infants <1year

A
  • Staph aureus
  • Group B streptococci
  • E. coli (especially <1 month)
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4
Q

Acute osteomyelitis-organisms in older children

A
  • Staph aureus
  • Strep pyogenes
  • Haemophilus influenzae
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5
Q

Acute osteomyelitis-organisms in adults

A
  • Staph aureus
  • coagulase negative staphylococci (prostheses)
  • Propionibacterium spp (prostheses)
  • Mycobacterium tuberculosis
  • Pseudomonas aeroginosa (esp. secondary to penetrating foot injuries, IVDAs)
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6
Q

Acute osteomyelitis-organisms in diabetic foot and pressure sores

A

-mixed infection including anaerobes

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7
Q

Acute osteomyelitis-organisms in sickle cell disease

A

-salmonella spp

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8
Q

Acute osteomyelitis-organisms in fisherman, filliters

A

-mycobacterium marinum

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9
Q

Acute osteomyelitis-organisms in AIDS

A

-Candida

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10
Q

Acute osteomyelitis pathology

A
  • starts at metaphysis
  • vascular stasis (venous congestion + arterial thrombosis)
  • acute inflammation – increased pressure
  • suppuration
  • release of pressure (medulla, sub-periosteal, into joint)
  • necrosis of bone (sequestrum)
  • new bone formation (involucrum)
  • resolution - or not (chronic osteomyelitis)
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11
Q

Acute osteomyelitis clinical features - infant

A
  • may be minimal signs, or may be very ill
  • failure to thrive
  • possibly drowsy or irritable
  • metaphyseal tenderness and swelling
  • decreased ROM
  • positional change
  • commonest around the knee
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12
Q

Acute osteomyelitis clinical features - child

A
  • severe pain
  • reluctant to move (neighbouring joints held flexed); not weight bearing
  • may be tender fever (swinging pyrexia) + tachycardia
  • malaise (fatigue, nausea, vomiting)
  • toxaemia
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13
Q

Acute osteomyelitis clinical features - adult

A
  • Primary OM seen commonly in thoracolumbar spine
    - backache
    - history of UTI or urological procedure
    - elderly, diabetic, immunocompromised
  • Secondary OM much more common
    - often after open fracture, surgery (esp. ORIF)
    - mixture of organisms
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14
Q

Acute osteomyelitis initial investigations

A
  • FBC + diff WBC (neutrophil leucocytosis)
  • ESR, CRP
  • blood cultures x3 (at peak of temperature – 60% +ve)
  • U&Es
  • X-ray (normal in the first 10-14 days)
  • ultrasound
  • aspiration
  • isotope Bone Scan (Tc-99, Gallium-67)
  • labelled white cell scan (Indium-111)
  • MRI
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15
Q

Acute osteomyelitis differential diagnosis

A
  • acute septic arthritis
  • acute inflammatory arthritis
  • trauma (fracture, dislocation, etc.)
  • transient synovitis (“irritable hip”)
  • soft tissue infection
    - cellulitis
    - erysipelas - superficial infection with red, raised plaque (Gp A Strep)
    - necrotising fasciitis
    - gas gangrene
    - toxic shock syndrome
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16
Q

Acute osteomyelitis diagnostic investigations

A
  • X-ray (normal in the first 10-14 days)
  • ultrasound
  • aspiration
  • isotope Bone Scan (Tc-99, Gallium-67)
  • labelled white cell scan (Indium-111)
  • MRI
17
Q

Acute Osteomyelitis Radiographs

A
  • early radiographs minimal changes
  • 10-20 days early periosteal changes
  • medullary changes - lytic areas
  • sequestrum - late osteonecrosis
  • involucrum - late periosteal new bone
18
Q

Acute osteomyelitis treatment

A
  • supportive treatment for pain and dehydration
  • rest & splintage
  • antibiotics
    - route (IV/oral switch – 7-10 days?)
    - duration (4-6 wks – depends on response, ESR)
  • surgery
19
Q

Acute osteomyelitis indications for surgery

A
  • aspiration of pus for diagnosis & culture
  • abscess drainage (multiple drill-holes, primary closure to avoid sinus)
  • debridement of dead/infected /contaminated tissue
  • refractory to non-operative Rx >24..48 hrs
20
Q

Acute osteomyelitis myelitis complications

A
  • septicemia, death
  • metastatic infection
  • pathological fracture
  • septic arthritis
  • altered bone growth
  • chronic osteomyelitis
21
Q

Chronic osteomyelitis cause

A
  • may follow acute osteomyelitis
  • may start de novo
    - following operation
    - following open fracture (possibly many years earlier)
    - immunosuppressed, diabetics, elderly, drug abusers, etc.
22
Q

Chronic osteomyelitis organism

A
  • often mixed infection
  • usually same organism(s) each flare-up
  • mostly Staph. Aureus, E. Coli, Strep. pyogenes, Proteus
23
Q

Chronic osteomyelitis complications

A
  • chronically discharging sinus + flare-ups
  • ongoing (metastatic) infection (abscesses)
  • pathological fracture
  • growth disturbance + deformities
  • squamous cell carcinoma (0.07%)
24
Q

Chronic osteomyelitis treatment

A
  • long-term antibiotics
    - local (gentamicin cement)
    - systemic (orally/ IV)
  • eradicate bone infection- surgically (multiple operations)
  • treat soft tissue problems
  • deformity correction
  • massive reconstruction
  • amputation
25
Q

Acute septic arthritis pathology

A
  • acute synovitis with purulent joint effusion
  • articular cartilage attacked by bacterial toxin and cellular enzyme
  • complete destruction of the articular cartilage
26
Q

Acute Septic Arthritis Sequelae

A 
-complete recovery
or
-partial loss of the articular cartilage and subsequent OA
or
-fibrous or bony ankylosis
27
Q

Acute Septic Arthritis Organism

A
  • Staphylococus aureus
  • Haemophilus influenzae
  • Streptococcus pyogenes
  • E. coli
28
Q

Acute Septic Arthritis Neonate Presentation

A
  • picture of septicaemia
  • irritability
  • resistant to movement
29
Q

Acute Septic Arthritis Child/Adult Presentation

A
  • Acute pain in single large joint
  • reluctant to move the joint (any movement)
  • increase temperature and pulse
  • increase tenderness
30
Q

Acute septic arthritis investigations

A
  • FBC, WBC, ESR, CRP, blood cultures
  • X ray
  • ultrasound
  • aspiration
31
Q

Acute septic arthritis differential diagnosis

A
  • acute osteomyelitis
  • trauma
  • irritable joint
  • haemophilia
  • rheumatic fever
  • gout
  • Gaucher’s disease
32
Q

Acute Septic Arthritis Treatment

A
  • general supportive measures
  • antibiotics (3-4 weeks)
  • surgical drainage & lavage
33
Q

Tuberculosis Bone and Joint Classification

A
  • extra-articular (epiphyseal / bones with haemodynamic marrow)
  • intra-articular (large joints)
  • vertebral body
34
Q

Tuberculosis Clinical Features

A
  • insidious onset & general ill health
  • contact with TB
  • pain (esp. at night), swelling, weight loss
  • low grade pyrexia
  • joint swelling
  • decreased ROM
  • ankylosis
  • deformity
35
Q

Tuberculosis pathology

A
  • primary complex (in the lung or the gut)
  • secondary spread
  • tuberculous granuloma
36
Q

Spinal tuberculosis presentation

A
  • little pain

- present with abscess or kyphosis

37
Q

Tuberculosis investigations

A
  • FBC , ESR
  • Mantoux test
  • Sputum/ urine culture
  • X-ray
    - soft tissue swelling
    - periarticular osteopaenia
    - articular space narrowing
  • Joint aspiration and biopsy
38
Q

Tuberculosis Differential Diagnosis

A
  • transient synovitis
  • monoarticular RA
  • haemorrhagic arthritis
  • pyogenic arthritis
  • Tumour
39
Q

Tuberculosis treatment

A 
initial -rifampicin    
             isoniazid          8 weeks
             ethambutol
then - rifampicin and isoniazid 6-12 month
-rest and splintage
-operative drainage rarely necessary

MSK (24 decks)

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