Infection in Orthopaedics

Question 1

common bacteria in bone and soft tissue infections

Answer 1

Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate

Question 2

clinical features of a patient presenting with sepsis

Answer 2

qSOFA
-RR>22
BP<100
-altered mental state

Question 3

define sepsis and septic shock

Answer 3

sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection

septic shock: a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’*

Question 4

describe sepsis 6

Answer 4

1. Administer oxygen: Aim to keep saturations > 94% (88-92% if at risk of CO2 retention e.g. COPD)
2. Take blood cultures
3. Give broad-spectrum antibiotics
4. Give intravenous fluid challenges
   NICE recommend a bolus of 500ml crystalloid over less than 15 minutes
5. Measure serum lactate
6. Measure accurate hourly urine output

Question 5

aspects of sofa score 7

Answer 5

PaO2/FiO2

platelets

bilirubin

cardiovacscular

GCS

creatinine

urine output

Question 6

describe the two types of necrotising fasciitis

Answer 6

type 1
-mixed anaerobes and aerobes
-often occurs post surgery in diabetics

type 2
-caused by streptococcus pyogenes

Question 7

risk factors for necrotising fasciitis 4

Answer 7

skin factors
-recent trauma
-recent burns
-recent soft tissue infection

DM
-most common preexisitng medical condition
-particularly if patient treated with SGLT-2 inhibitors

IVDU

immunosuppression

Question 8

most commonly affected site by necrotising fasciitis

Answer 8

perineum (Fournier’s gangrene)

Question 9

features of necrotising fasciitis 5

Answer 9

acute onset

pain, swelling, erythema at affected site
-often presents as rapidly worsening cellulitis with pain out keeping with physical features
-extremly tender over infected tissue with hypoaethesia to light touch
-skin necrosis and crepitus/gas gangrene are late signs

fever and tachycardia may be absent or occur in late presentation

Question 10

managemenrt of necrotising fasciitis 3

Answer 10

urgent surgical referral debridement

IV ABx

IV fluid ressu

Question 11

define palm abscess

Answer 11

purulent infection of deep spcaes in the palm

typically with staph or strep

Question 12

types of hand abscess

Answer 12

collar-button abscesses
-arising in the web space between two fingers

thenar space abscesses

midpalmar space abscess

Question 13

presentation of hand abscess

Answer 13

intense throbbing pain occurs with swelling and severe tenderness on palpation

Question 14

diagnosis of hand abscess

Answer 14

xray to detect foreign bodies

otherwise clinical diagnosis

Question 15

management of hand abscess 2

Answer 15

incision and drainage in the operating room (with cultures)

and ABx