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B - Paediatrics MANAGEMENT > Osteomyelitis > Flashcards

Osteomyelitis Flashcards

1
Q

What is osteomyelitis?

A

An infection of the bone

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2
Q

What bones are principally affected in osteomyelitis?

A

Long bones, with tiba > fibia > humerus

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3
Q

What can osteomyelitis be divided into?

A
  • Acute
  • Subacute (2-3 weeks)
  • Chronic
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4
Q

Where in the bone is infection usually seen in osteomyelitis?

A

In the metaphyseal region of bones

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5
Q

How does infection get to the bone in osteomyelitis?

A
  • Haematogenous route
  • Direct inoculation
  • Local extension from adjacent sites
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6
Q

Where does the infection come from when it is spread via haematogenous route in osteomyelitis?

A

Most infections are spread from a site of entry, e.g. respiratory, GI, ENT, or skin sites

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7
Q

What might cause direct inoculation of infection causing osteomyelitis?

A
  • Open fractures

- Penetrating wounds

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8
Q

When can infection spread to the adjacent joint?

A

In the infant

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9
Q

Why can infection spread to the adjacent joint in the infant?

A

Because the transphyseal vessels are patent

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10
Q

How does infection tend to spread in adolescents?

A

Through the medullary canal

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11
Q

Can organisms be isolated on testing in osteomyelitis?

A

Not always

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12
Q

Why can organisms not always be isolated in osteomyelitis?

A

The yield for bacterial growth from synovial fluid and bone aspirate is small

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13
Q

What is the most common bacteria causing osteomyelitis in all age groups?

A

S. Aureus

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14
Q

What other organisms can cause osteomyelitis in neonates?

A
  • Group B streptococcus

- Gram -ve enteric bacilli

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15
Q

What other organisms can cause osteomyelitis in <2 years?

A

Haemophilus influenzae

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16
Q

What other organisms can cause osteomyelitis in >2 years?

A
  • Gram +ve cocci

- Pseudomonas aeruginosa

17
Q

What other organisms can cause osteomyelitis in adolescents?

A

Neisseria gonorrhoeae

18
Q

What are the risk factors for osteomyelitis?

A
  • Infant

- Male

19
Q

What % of cases of osteomyelitis occur in the first 2 years?

A

33%

20
Q

How does the presentation of osteomyelitis differ in infants compared to older children?

A

The presentation is more insidious in infants, in whom swelling or reduced limb movement is the initial sign

21
Q

How does osteomyelitis present in older children?

A
  • Pain
  • Limping
  • Refusal to walk/weight bear
  • Fever
  • Malaise
  • Flu-like symptoms
  • Overlying bone tenderness, with or without swelling
22
Q

What might occur in the adjacent joint in osteomyelitis?

A

Sterile effusion

23
Q

What investigations should be done in osteomyelitis?

A
  • Bloods
  • X-ray affected bone
  • US-guided aspiration
  • MRI
  • Open biopsy may be necessary
24
Q

What bloods should be done in osteomyelitis?

A
  • FBC
  • ESR
  • CRP
  • Blood cultures
25
Q

In what % of cases of osteomyelitis are blood cultures positive?

A

50%

26
Q

What might be found on x-ray of bone in the early stages of osteomyelitis?

A

May be normal, possibly with soft tissue oedema visible

27
Q

What might be found on x-ray of bone in late stages of osteomyelitis?

A

Metaphyseal rarefaction

28
Q

When do destructive changes in bone appear on x-ray in osteomyelitis?

A

After 10 days

29
Q

What is the purpose of US-guided aspiration in osteomyelitis?

A

For microscopy and culture

30
Q

What is the purpose of MRI in osteomyelitis?

A

Soft tissue assessment

31
Q

What might be found on MRI soft tissue assessment in osteomyelitis?

A
  • Bone marrow involvement
  • Abscess formation
  • Joint effusion
  • Subperisoteal extension
32
Q

What are the differential diagnoses of osteomyelitis?

A
  • Septic arthritis
  • Osteosarcoma
  • Trauma or fracture
  • Rheumatoid disease
  • Toxic synovitis
33
Q

What is involved in the medical management of osteomyelitis?

A

IV antibiotics for a minimum of 2 weeks, or until clinical recovery with acute-phase reactants normalising, followed by oral antibiotics for 4 weeks

34
Q

What is required when deciding on antibiotics for osteomyelitis?

A

Early liason with microbiologist

35
Q

What are the surgical options in the management of osteomyelitis?

A
  • Aspiration or surgical decompression of subperiosteal space
  • Surgical drainage
36
Q

When might aspiration or surgical decompression of the subperiosteal space be performed?

A

If the presentation is atypical, or in immunodeficient children

37
Q

When is surgical drainage performed in osteomyelitis?

A

If the condition does not respond rapidly to antibiotic therapy

38
Q

What is done to the limb in osteomyelitis, in terms of mobilisation?

A

The affected limb is usually rested in a splint, then mobilised

39
Q

What are the potential complications of osteomyelitis?

A
  • Sepsis
  • Pathological fractures
  • Sequesteration
  • Growth disturbance

B - Paediatrics MANAGEMENT (106 decks)

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