Bone and Soft Tissue Infection

Question 1

What is osteomyelitis?

Answer 1

Bone infection

Question 2

Risk factors of osteomyelitis

Answer 2

Mostly children
Boys > girls
History of trauma
Other disease
   - Diabetes
   - Rheumatoid arthritis
   - Immune compromise
   - Long term steroid treatment
   - Sickle cell

Question 3

Osteomyelitis source of infection

Answer 3

Haematogenous spread
Local spread from contiguous site of infection – trauma
Secondary to vascular insufficiency

Question 4

Acute osteomyelitis organisms < 1 year

Answer 4

Staph aureus
Group B streptococci
E. coli

Question 5

Acute osteomyelitis organisms older children

Answer 5

Staph aureus
Strep pyogenes
Haemophilus influenzae

Question 6

Acute osteomyelitis organisms adults

Answer 6

Staph aureus

Question 7

Acute osteomyelitis pathology

Answer 7

Starts at metaphysis
Acute inflammation – increased pressure
Necrosis of bone
New bone formation

Question 8

Presentation of acute myelitis (infant)

Answer 8

May be minimal signs, or may be very ill
Failure to thrive
Poss. drowsy or irritable
Metaphyseal tenderness + swelling
Decrease ROM
Positional change
Commonest around the knee

Question 9

Presentation of acute myelitis (child)

Answer 9

Severe pain 
Reluctant to move
Fever + tachycardia
Malaise
Toxaemia

Question 10

Presentation of acute myelitis (adult)

Answer 10

Primary OM seen commonly in thoracolumbar spine
Backache
History of UTI or urological procedure
Elderly, diabetic, immunocompromised

Question 11

Soft tissue infection

Answer 11

Cellulitis
Erysipelas
Necrotising fasciitis 
Gas gangrene 
Toxic shock syndrome

Question 12

Acute osteomyelitis diagnosis

Answer 12

X-ray
Ultrasound
Aspiration
MRI

Question 13

Sequestrum

Answer 13

Late osteonecrosis

Question 14

Involucrum

Answer 14

Late periosteal new bone

Question 15

Acute osteomyelitis

Answer 15

Supportive treatment for pain and dehydration
Rest & splintage
Antibiotics
Surgery

Question 16

Chronic osteomyelitis organisms

Answer 16

Often mixed

mostly:
Staph. Aureus
E. Coli
Strep. pyogenes
Proteus

Question 17

Chronic osteomyelitis treatment

Answer 17

Long-term antibiotics
Eradicate bone infection- surgically
Treat soft tissue problems

Question 18

What is septic arthritis?

Answer 18

Joint infection

Question 19

Acute septic arthritis route of infection

Answer 19

Haematogenous
Eruption of bone abscess
Direct invasion
   - Penetrating wound
   - Intra-articular injury
   - Arthroscopy

Question 20

Septic arthritis organisms

Answer 20

Staphylococus aureus
Haemophilus influenzae
Streptococcus pyogenes
E. coli

Question 21

Acute septic arthritis pathology

Answer 21

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Complete destruction of the articular cartilage

Question 22

Acute septic arthritis sequelae

Answer 22

Complete recovery
Partial loss of the articular cartilage and subsequent OA
Fibrous or bony ankylosis

Question 23

Neonatal presentation of acute septic arthritis

Answer 23

Picture of septicaemia =>
Irritability
Resistant to movement
Ill

Question 24

Child/adult presentation of acute septic arthritis

Answer 24

Acute pain in single large joint
Reluctant to move the joint
Increase temp. and pulse
Increase tenderness

Question 25

What is the most common cause of acute septic arthritis in adults?

Answer 25

Infected joint replacement

Question 26

Acute septic arthritis treatment

Answer 26

General supportive measures | Antibiotics

Question 27

Classification of TB bone and joint

Answer 27

Extra-articular (epiphyseal / bones with haemodynamic marrow) Intra-articular (large joints) Vertebral body

Question 28

TB clinical presentation

Answer 28

``` Insidious onset & general ill health Contact with TB Pain (esp. at night), swelling, loss of weight Low grade pyrexia Joint swelling Decrease ROM Ankylosis Deformity ```

Question 29

TB pathology

Answer 29

Primary complex (in the lung or the gut) Secondary spread Tuberculous granuloma

Question 30

Spinal tuberculosis presentation

Answer 30

Little pain | Present with abscess or kyphosis