Bone and Joint Infections - Spivak - From Cutler

Question 1

What are the hematogenous source of Osteomyelitis?

Answer 1

• Staph aureus
• Gram Neg rods
• Coagulase neg Staphylococci

Question 2

What are three broad sources of getting osteomyelitis?

Answer 2

• Hematogenous (monomicrobial)
• Contiguous spread (periodontal)
• Direct inoculation (result of trauma or surgery)

Question 3

What location of the body do we see hematogenous osteomylitis in children?

Answer 3

-long bones

Question 4

What location of the body do we see hematogenous osteomyelitis in adults?

Answer 4

-Vertebrae

Question 5

What is sequestra?

Answer 5

-Separated dead bone

Question 6

In the anatomic classification of osteomyelitis what is Stage 1?

Answer 6

-Medullary

Question 7

In the anatomic classification of osteomyelitis what is stage 2?

Answer 7

-Superficial (involves only the cortical bone)

Question 8

In the anatomic classification of osteomyelitis what is stage 3?

Answer 8

-Localized (involves both cortical and medullary bone, but doesn’t involve the entire diameter of the bone)

Question 9

In the anatomic classification of osteomyelitis what is stage 4?

Answer 9

-Diffuse (involve the entire thickness of the bone)

Question 10

If you have infection prior to development of sequestra do you have acute or chronic osteomyelitis?

Answer 10

-Acute

Question 11

If you have an acute classification of osteomyelitis what is the time frame you have to be in?

Answer 11

-Less than 2 weeks

Question 12

If you have an infection after sequestra have formed to you have acute or chronic osteomyelitis?

Answer 12

-Chronic

Question 13

What are three hallmarks that you find in chronic osteomyelitis?

Answer 13

• Formation of involucrum (new bone development)
• Bone loss
• Sinus tract formation

Question 14

If you have chronic osteomyelitis can you treat it with antibiotics alone?

Answer 14

-No it will also require surgery

Question 15

What are the acute clinical presentations of osteomyelitis?

Answer 15

• Gradual onset over several days
• Dull pain/local tenderness on exam
• Warmth, erythema, swelling, fevers may happen
• Septic arthritis (possibly)

Question 16

What are the chronic clinical presentations of osteomyelitis?

Answer 16

• Mild pain over several weeks
• Localized swelling or erythema
• Draining sinus tract

Question 17

If you are looking for acute osteomyelitis can you see it typically on a plain x-ray?

Answer 17

• No usually takes an MRI

- Chronic you can see on a radiograph

Question 18

How do you treat acute osteomyelitis?

Answer 18

-3-6 weeks antibiotics and possibly surgery

Question 19

What is the gold standard of osteomyelitis diagnosis?

Answer 19

-Bone biopsy

Question 20

How do you treat chronic osteomyelitis?

Answer 20

-3-6 weeks antibiotics with surgery

Question 21

What usually causes osteomyelitis of the jaw?

Answer 21

-Contiguous (spread from somewhere else) (NOT HEMATOGENOUS)

Question 22

Is the mandible or maxilla more susceptible to osteomyelitis of the jaw?

Answer 22

-Mandible

Question 23

T/F The lingual aspect of the mandible in region of molar teeth is the greatest risk for osteomyelitis

Answer 23

True

Question 24

What are the symptoms of osteomyelitis of the jaw?

Answer 24

-Mandibular pain-Anesthesia/paresthesia on affected side-Lymphadenopathy-Progress to trismus

Question 25

What is the treatment for osteomyelitis of the jaw?

Answer 25

-Combo of surgery and antibiotics targeting oral flora

Question 26

What are two types of medicines that are associated with osteonecrosis of the jaw?

Answer 26

• Antiresorptive (like bisphosphonates)

- Antiangiogenic

Question 27

What are the leading cause of arthroplasty failure?

Answer 27

-Prosthetic Joint Infections

Question 28

What type of bacteria cause Prosthetic joint infections?

Answer 28

• gram + cocci (65%)
• Aerobic gram Neg bacilli 6%
• anaerobes 4%
• Polymicrobial 20%

Question 29

What are five surgical management options to treat Prosthetic joint infections?

Answer 29

• Debridement and retention
• 2 stage exchange
• 1 stage exchange
• Resection arthroplasty with arthrodesis (fusion)
• Amputation

Question 30

When you do a debridement and retention surgery for PJIs what type of therapy do you do for treatment?

Answer 30

-2-6 weeks of IV therapy + rifampin

Question 31

T/F In general, for patients with prosthetic joint implants, prophylactic antibiotics are recommended prior to dental procedures to prevent prosthetic joint infections.

Answer 31

False-Antibiotics are not recommended

Question 32

how do you diagnose osteomyelitis best? What is the alternate way to diagnose?

Answer 32

based on culture of bacteria from bone biopsy along with pathology consistent with inflammation and osteonecrosis.
However sometimes you just need a positive blood culture

Question 33

what are the risk factors for Osteomyelitis of the Jaw?

Answer 33

dental infection, compound fracture, irradiation, Diabetes mellitus, steroid use