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MSK AM > Infection in bone and joints > Flashcards

Infection in bone and joints Flashcards

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1
Q

What is osteomyelitis?

A

Bone infection

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2
Q

Who is acute osteomyelitis most often seen in?

A

Young boys with a history of minor trauma

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3
Q

What conditions is osteomyelitis associated with?

A 
Diabetes
Rheumatoid arthritis
Immune compromised
Long term steroids
Sickle cell
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4
Q

What are the causes of osteomyelitis?

A

Haematenogous spread
Local spread
Secondary to vascular insufficiency

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5
Q

What can development of osteomyelitis in infants be caused by?

A

Infected umbilical cord

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6
Q

What can development of osteomyelitis in children be caused by?

A

Boils and abrasions

Tonsilitis

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7
Q

What can development of osteomyelitis in adults be caused by?

A

UTI

Arterial line

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8
Q

Who is haematogenous spread of acute osteomyelitis seen in?

A

Mostly children and elderly

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9
Q

What are the causes of local spread of osteomyelitis?

A

Trauma- open fracture
Bone surgery
Joint replacement

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10
Q

What is the most common causative organisms of osteomyelitis?

A

Staph aureus

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11
Q

What are the bacterial causes of acute osteomyelitis in infants?

A

Staph aureus
Group B strep
E. coli- most common in <1 month olds

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12
Q

What are the bacterial causes of acute osteomyelitis in children?

A

Staph aureus
Strep pyogenes
H. influenzae

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13
Q

What are the bacterial causes of osteomyelitis in adults?

A

Staph aureus
Coag - staph with prothesis
Mycobacterium TB
Pseudomonas aeroginosa in penetrating injury

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14
Q

What can cause osteomyelitis in someone with sickle cell disease?

A

Salmonella species

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15
Q

What can cause osteomyelitis in someone with HIV/AIDS?

A

Candida

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16
Q

What causes osteomyelitis most often in diabetic foot disease?

A

Mixed, including anaerobes

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17
Q

Where does osteomyelitis most often occur?

A

Metaphysis of long bones- distal femur, proximal tibia, proximal humerus…
Joints with intra-articular metaphysics- hip, elbow

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18
Q

What is the process of osteomyelitis?

A 
Starts at metaphysis
Vascular stasis
Acute inflammation
Suppration (pus formation)
Release of pressure
Necrosis of bone
New bone formation
REsolution
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19
Q

What are the clinical features of acute osteomyelitis in an infant?

A 
May be minimal signs, may be very ill
Failure to thrive
Drowsy, irritable
Metaphyseal tenderness or swelling
Decreased range of movement
Positional change
Commonest around knee
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20
Q

What are the clinical features of acute osteomyelitis in children?

A 
Severe pain
Reluctant to move, not weight bearing
Swinging pyrexia
Tachycardia
Malaise
Toxaemia
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21
Q

What are the clinical features of primary osteomyelitis in adults?

Study These Flashcards
A

Thoracolumbar spine
Backache, pyrexia, history of UTI or urological procedure
Elderly, diabetic, immunocompromised

22
Q

What are the clinical features of secondary osteomyelitis in adults?

Study These Flashcards
A

Often after open fracture or surgery
Mixture of organisms
More common

23
Q

How is osteomyelitis diagnosed?

Study These Flashcards
A 
History and examination
Bloods
Microbiology
Xray
US
Aspiration
Isotope bone scan
Labelled white cell scan MRI
24
Q

What bloods are done for suspected osteomyelitis?

Study These Flashcards
A

FBC, WCC
ESR, CRP
Blood cultures x3
U&E

25
What can be seen on xray with osteomyelitis?
In first 2 weeks, little 10-20 days- early periosteal changes Medullary changes
26
What us the differential for acute osteomyelitis?
``` Acute septic arthritis Acute inflammatory arthritis Trauma Transient synovitis Soft tissue infection ```
27
What is the treatment of acute osteomyelitis?
Supportive Rest and splint Antibiotics- IV or oral for 4-6 weeks Surgery
28
What are the indications for surgery in acute osteomyelitis?
Aspiration of pus for diagnosis and culture Abscess drainage Debridement of dead, infected or contaminated tissue
29
What are the possible complications of acute osteomyelitis?
``` Septicaemia Metastatic infection Pathological fracture Septic arthritis Altered bone growth Chronic osteomyelitis ```
30
What can cause chronic osteomyelitis?
Can follow acute or start de novo
31
What are the common causative organisms of chronic osteomyelitis?
Mixed infection | Staph aureus, e. coli, strep pyogenes, proteus species
32
What is the pathology of chronic osteomyelitis?
Cavities Dead bone New bone formation Chronic inflammation
33
Wha is the treatment of chronic osteomyelitis?
``` Long term antibiotics- local or systemic Eradication surgery Treat soft tissue problems Deformity correction Massive reconstruction Amputation ```
34
What are the possible complications of chronic osteomyelitis?
``` Chronically discharging sinus and flare ups Ongoing infection Pathological fracture Growth disturbance and deformities Squamous cell carcinomas ```
35
What are the routes of infection of acute septic arthritis?
Haematogenous Eruption f bone abscess Directly invasive- penetrating wound, intra-articular injury, arthroscopy Infected joint replacement- most common
36
What are the common bacterial causes of acute septic arthritis?
Staph aureus H. influenzae, Strep pyogenes E. coli
37
What is the pathology of acute septic arthritis?
Acute synovitis with purulent joint effusion Articular cartilage attacked by bacterial toxin and cellular enzyme Complete destruction of cellular cartilage
38
What are the possible outcomes of acute septic arthritis?
Recovery Partial loss of articular cartilage and subsequent osteoarthritis Fibrous or bone ankyloses
39
What are the clinical features of acute septic arthritis in neonates?
Septicaemia Irritability Ill Resistant to movement
40
What are the clinical features of acute septic arthritis in children and adults?
``` Acute pain in single large joint Reluctant to move Pyrexia Tachycardia Tenderness ```
41
How is acute septic arthritis diagnosed?
FBC, WCC, ESR, CRP, blood cultures Xray US Aspiration
42
What is the differential for acute septic arthritis?
``` Acute osteomyelitis Trauma Irritable joint Haemophilia Rheumatic fever Gout GAucher's disease ```
43
What is the treatment of acute septic arthritis?
Supportive Antibiotics- 3-4 weeks Surgical drainage and lavage- in emergency setting
44
What are the classifications of TB?
Extra-articular Intraarticular Vertebral body
45
What is the pathology of TB?
Primary complex- often in lung or gut Secondary spread TB granuloma
46
What are the clinical features of joint TB?
``` Insidious onset and general ill health Contact with TB Pain, esp at night Swelling Weight loss Pow grade pyrexia Joint swelling Decreased range of movement Ankylosis Deformity Marked thickening of synovial Marked muscle wasting Periarticular osteoporosis ```
47
What are the clinical features of spinal TB?
Little pain Vertebral body collapse Abscess or kyphosis
48
What investigations ae done for joint TB?
``` FBC, ESR Mantoux test Sputum/urine culture Xray Joint aspiration and biopsy ```
49
What is the differential for joint TB?
Transient synovitis Monoarticular arthritis Pyogenic arthritis Tumour
50
What is the treatment of TB?
6 months rifampicin and isoniazid 2 months ethambutol and pyramidazole Resp and splintage Operative drainage

MSK AM (37 decks)

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