Infection in Bones and Joints

Question 1

Acute osteomyelitis

Answer 1

Infection in bone

Question 2

Who tends to get acute osteomyeltitis

Answer 2

Children, males

Question 3

History of disease in acute osteomyelitis

Answer 3

Diabetes, arthritis, immune compromise, long term steroid use, sickle cell anaemia

Question 4

What is the usual source of infection of acute osteomyelitis

Answer 4

Usually blood borne and tends to be from a local spread of infection.

Question 5

Usual cause of acute osteomyelitis in infants

Answer 5

Infected umbilical chord

Question 6

Usual cause of acute osteomyelitis in children

Answer 6

Boils, tonsilitis, skin abrasions

Question 7

Usual cause of acute osteomyeltitis in adults

Answer 7

UTI or vascular line

Question 8

Most common organism to cause acute osteomyelitis

Answer 8

Staphylococcus Aureus

Question 9

Organism cause of acute osteomyelitis in infants

Answer 9

Staph, group B strep and Ecoli

Question 10

Organism cause of acute osteomyelitis in children

Answer 10

Streptococcus pyogenes and H.influenza

Question 11

Organism cause of acute osteomyelitis in adults

Answer 11

Staph aureus, coagulase negative strep, strep pyogens

Question 12

Mixed infection osteomyeleitis tends to occur when

Answer 12

Diabetic foot and pressure sores

Question 13

Patients with sickle cells disease can get what organism AO

Answer 13

Salmonella

Question 14

Describe the pathogenesis of Acute Osteomyelitis

Answer 14

The infection starts at the metaphysis resulting in vascular stasis, inflammation, suppuration and then a release of pressure (into the medulla, subperiosteal space of the joint). There is then necrosis of the bone (sequestrum). The bone then tries to heal itself by forming new bone (involcrum). If treatment is started early there can be resolution.

Question 15

Presentation of Acute Osteomyelitis in infants

Answer 15

Failure to thrive, drowsy and irritable, metaphyseal tenderness and swelling, decreased range of movement in one limb and may be positional change

Question 16

Presentation of Acute Osteomyelitis in Children

Answer 16

Severe pain, reluctant to move and no bearing of weight, always consider the hip if there is knee pain, fever and tachycardia, there may also be malaise

Question 17

Presentation of Acute Osteomyelitis in Adults

Answer 17

Often in the back, back pain (keeps the patient awake during the night), history of UTI or urological procedure, elderly, diabetic. Secondary infection (after surgery or open fracture more common)

Question 18

How is acute osteomyelitis diagnosed

Answer 18

FBC and increase WCC, raised ESR and CRP, three blood cultures taken, U+Es (ill and dehydrated), X-ray (showing metaphyseal destruction after 14 days), US, Aspiration, Isotope bone scan, labelled WCS

Question 19

Best way to diagnose Acute Osteomyelitis

Answer 19

MRI

Question 20

State the microbiological tests conducted into Acute Osteomyelitis

Answer 20

Blood culture, bone biopsy, tissue or swabs from up to five sites around implant at debridement in prosthetic infection

Question 21

How is Acute Osteomyelitis Managed

Answer 21

Analgesia and fluids, rest and splintage, antibiotics for 4-6 weeks (the usual choice being fluxociliin and benzylpenicillin), monitor ESR

Question 22

Indications for surgical treatment in Acute Osteomyelitis

Answer 22

Aspiration of pus for diagnosis

Abscess drainage

Debridement of dea or infection tissue or bone

Refractory to non-operative treatment >24-48 hours

Question 23

Complications of acute osteomyelitis

Answer 23

• Septicaemia
• Metastatic infection
• Pathological fracture
• Septic arthritis
• Altered bone growth
• Chronic osteomyelitis

Question 24

Subacute osteomyelitis

Answer 24

Infection of the bone that occurs in a patient with a good immune system or a bacteria with lowered virulence

Question 25

Clinical features of subacute osteomyelitis

Answer 25

Longer history, variable symptoms in the pain or lump, localised swelling and tenderness

Question 26

Brodies Abscness

Answer 26

Subacute osteomyelitis in older children with painful limb and no systemic features

Question 27

Treatment of subacute osteomyelitis

Answer 27

Curategge and prolonged course of antibiotics

Question 28

Chronic osteomyelitis clinical features

Answer 28

Has a more slow onset, fever, pain, redness or discharge at the site of infection. May be periods of remission

Question 29

State the main organisms in chronic osteomyelitis

Answer 29

Staph aureus, E.coli, strep pyogenes, proteus

Question 30

Pathology of chronic osteomyelitis

Answer 30

Cavitis, sinuses, alongside areas of sequestra.

Question 31

Treatment of chronic osteomyelitis

Answer 31

Multiple debridement, local and systemic antibiotics (gentamicin cement and oral or IV antibiotics)

Question 32

Complications of chronic osteomyelitis

Answer 32

Chronically discharging sinus and recurrent flare ups, ongoing infection, pathological fractures, growth disturbances and deformities, squamous cell carcinoma

Question 33

Acute Septic Arthritis

Answer 33

Inflammation of a joint caused by infection

Question 34

How does septic arthritis occur

Answer 34

Direct invasion from a penetrating wound, intra-articular injury, arthroscopy, eruption of bone abscesses or haematological spread

Question 35

State the common causative organisms of septic arthritis

Answer 35

* Staph aureus * H.influenza * Strep.pyogens * E.coli

Question 36

Pathology of acute septic arthritis

Answer 36

Acute synovitis with purulent joint effusion. The articular cartilage is attakced by bacterial toxin and cellular enzymes resulting in complete destruction of it

Question 37

Presentation of septic arthritis in neonates

Answer 37

Septicaemia

Question 38

Presentation of septic arthritis in children

Answer 38

Acute pain in a single largely swollen joint in which the patient is reluctant to move, increased temperature and pulse.

Question 39

Presentation of septic arthritis in adults

Answer 39

Superficial joint involvement

Question 40

Investigations of septic arthritis

Answer 40

FBC, WBC, EST, CRP, blood cultures. The X-ray tends to not show very much; ultrasound will show intense effusion within the joint. Aspiration is often helpful in diagnosing the organism responsible.

Question 41

Treatment of septic arthritis

Answer 41

Antibiotics, surgical drainage and lavage

Question 42

Clinical Features of bone TB

Answer 42

insidious onset and general ill health, contact with TB, pain, swelling, loss of weight, low grade pyrexia, joint swelling, decreased range of movement, ankyloses and deformity

Question 43

Spinal TB presentation

Answer 43

Little pain, presents with abscess of kyphosis

Question 44

Investigation of BONE TB

Answer 44

FBC, ESR, mantoux test, sputum/urine culture. May see changes on X-ray – soft tissue swelling, periarticular osteopaenia and articular space narrowing.

Question 45

Treatment of bone TB

Answer 45

It tends to involve mainly chemotherapy: rifampicin, isoniazid, ethambutol for 8 weeks then rifampicin and isoniazid for six to twelve months