bone & joint infections

Question 1

acute osteomyelitis is more common in?

Answer 1

children (boys>girls)

history of trauma could determine its site

Question 2

How is the blood stream invaded in osteomyelitis?

Answer 2

infants: infected umbilical cord
adults: urrethral catheter, arterial lines
boils
tonsilities
skin abrasions
dirty needles

Question 3

What are the organisms that could cause osteomyelitis?

Answer 3

• STAPH. AUREUS
• strep pyogens
• strep. pneumonie
• H. influenza
• E. coli
• pseudomonas auriginosa
• proteus mirabilis

Question 4

how does osteomyelitis progress?

Answer 4

infection at METAPHYSIS —> vascular stasis favours bacterial colonization —-> inflammation —> suppuration —-> bone necrosis —> reactive new bone formation —> resolution

Question 5

if a patient presents to you in severe pain, fever, malaise, is reluctant to move, and has signs of toxemia, what will be your provisional diagnosis?

Answer 5

osteomyelitis

Question 6

What are the clinical features of osteomyelitis in infants?

Answer 6

• failure to thrive
• drowsy
• irritable
• metaphyseal tenderness
• decreased range of motion (common around knees)

Question 7

What are the clinical features of osteomyelitis in adults?

Answer 7

• fever
• backache
• history of UTI following urological procedure
• history of diabetes or immunosuppression (thoracolumbar spine)

Question 8

What are the diagnostic tools used to diagnose osteomyeitis?

Answer 8

• history & examination
• CRP & ESR are the parameters for joint infection
• x-ray will be normal in the first 10-14 days
• Gallium 67 will clearly show infection
• aspiration if its huge and can be aspirated

Question 9

what is the differential diagnosis of osteomyelitits?

Answer 9

• cellulitis
• acute septic arthritis
• acute rheumatism
• sickle cell crisis
• Gaucher’s disease

Question 10

How should osteomyelitis be treated?

Answer 10

• supportive treatment for pain & dehydration
• splintage
• antibiotics if acute
• surgery for subacute & chronic

Question 11

complications of acute osteomyelitis?

Answer 11

• septicemia
• metastatic infection
• septic arthritis
• altered bone growth
• chronic osteomyelitis

Question 12

subacute osteomyelitis usually occurs in?

Answer 12

immunocompromised patients

Question 13

brodies abscess is found in which bone infection?

Answer 13

SUBACUTE OSTEOMYELITIS

• has a rigid cortex
• local tenderness
• limp & slight swelling
• pain for several weeks or months

Question 14

What are the investigation done for subacute osteomyelitis?

Answer 14

• x ray
• bone scan
• biopsy (grow organism)

Question 15

How should subacute osteomyelitis be treated?

Answer 15

• antibiotics for 6 months

- surgery

Question 16

which bone infection frquently follows open fractures or operations?

Answer 16

chronic osteomyelitis

Question 17

What organisms cause chronic osteomyelitis?

Answer 17

usually a mixed infection due to open fractures

• Staph. aureus
• E. coli
• strep. pyogens
• proteus mirabalis

Question 18

What is the pathogenesis of chronic osteomyelitis?

Answer 18

destruction of bone —> cavities containing pus & pieces of dead bone (sequestra) —> chronic reactive new bone takes form of involucrum

Question 19

What is the histological picture of chronic osteomyelitis?

Answer 19

chronic inflammation

Question 20

How should chronic osteomyelitis be treated?

Answer 20

antibiotic (4-6 weeks)
surgery 
- sequestrectomy 
- muscle flap 
- double lumen tube 
- ilizarov fixation

Question 21

What are the other types of osteomyelitis?

Answer 21

post-operative osteomyelitis 
- early (within 3 months)
- late 
Sclerosing osteomyelitis 
- non-suppurative

Question 22

What are the routes of infection in acute septic arthritis?

Answer 22

• direct invasion
  
  • penetrating wound
  • intra-articular injection
  • arthroscopy
• eruption of bone abscess
• haematogenous

Question 23

What organisms cause acute septic arthritis?

Answer 23

• STAPH. AUREUS
• strep. pyogens
• H. influenza
• E. coli

Question 24

What is the pathology of acute septic arthritis?

Answer 24

acute synovitis with purulent joint effusion —> articular cartilage attacked by bacterial toxin & cellular enzyme —> complete destruction of articular cartilage

Question 25

sequelae of acute septic arthritis?

Answer 25

• complete recovery
• partial loss of articular cartilage
• fibrous or bony ankylosis

Question 26

acute septic arthritis in neonates resembles what?

Answer 26

septicemia

• irritability
• resistant to movement

Question 27

acute pain in a single large joint affects who?

Answer 27

Children in acute septic arthritis

• reluctant to move the joint
• increase in temp & pulse
• increase tenderness

Question 28

Which joints are affected in adults in case of acute septic arthritis?

Answer 28

• superficial joints (knee, ankle, wrist)

Question 29

What is the most important investigation in acute septic arthritis?

Answer 29

ASPIRATION

- if there is thick yellow pus prepare the OR

Question 30

What are the DD for acute septic arthritis?

Answer 30

• acute osteomyelitis
• trauma
• gout
• irritable joint
• hemophilia
• rheumatic fever
• Gaucher’s disease

Question 31

How should acute septic arthritis be treated?

Answer 31

• general supportive measures
• antibiotics
• surgical drainage