MSK Monash

Question 1

What are the common sites of osteomyelitis

Answer 1

Metaphysis of long bones- distal femur and proximal tibia

Question 2

Pathogens of osteomyelitis

Answer 2

Staph aureus
Streptococcus
Haemophilus influenza

Question 3

RF for osteomyelitis

Answer 3

Infected wound
Sickle cell anaemia
TB

Question 4

Presentation of osteomyelitis

Answer 4

Painful, immobile limb (pseudoparesis)
Swelling
Extreme tenderness
Sterile effusion of adjacent joint

Question 5

Ix of osteomyelitis

Answer 5

positive blood cultures (increased WBC, ESR, CRP)
X-ray- soft tissue swelling
US- periosteal elevation
MRI- subperiosteal pus, purulent debris

Question 6

Mx of osteomyelitis

Answer 6

parenteral antibiotics (IV then oral)
aspiration
surgical decompression of subperiosteal space
surgical drainage then rested in splint

Question 7

Age group of septic arthritis

Answer 7

<2 yo

Question 8

RF of SA

Answer 8

haematogenous spread
puncture wound
infected lesions (chickenpox)
adjacent osteomyelitis
immunodeficiency (sickle cell)

Question 9

Pathogen of SA

Answer 9

Staph aureus

H. influenzae (prior to Hib immunisation, multiple sites)

Question 10

Presentation of SA

Answer 10

erythematous
warm
acutely tender joint
reduced ROM
febrile
unwell (crying, nappy changing) when limb is moved
if hip- limp, pain referred to knee

Question 11

Ix of SA

Answer 11

definitive- aspiration of joint space under US guidance for organism & culture
Positive blood culture- increased WBC, CRP, ESR
US of deep joints- hip
X-ray- RO trauma, bony lesions, might see widening of joint space, soft tissue swelling
bone scan, MRI- adjacent osteomyelitis

Question 12

Mx of SA

Answer 12

Antibiotics (initially IV)
wash out of joint
surgical drainage
joint is initially immobilised