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Orthopaedics > Orthopaedic Infections > Flashcards

Orthopaedic Infections Flashcards

(51 cards)

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1
Q

Osteomyelitis usually occurs in

A

Young children or elderly population: D/t relatively low immunity

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2
Q

Routes/Source of infection for Osteomyelitis

A
  1. Hematogenous (M/C): From pre-existing infection
  2. Direct
  3. Post surgical
  4. Open fracture
  5. From septic arthritis
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3
Q

Etiology of Osteomyelitis

A
  1. Staph aureus: M/C in osteomyelitis overall, acute and chronic
  2. In sickle cell disease patients: Salmonella
  3. In IV drug abusers: Pseudomonas
  4. Foll animal bite: Pasteurella
  5. Foll human bite: Eikenella
  6. Prolonged parenteral therapy: Fungal organism
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4
Q

Site of Osteomyelitis

A

Metaphysis of long bone
M/C femur > Tibia

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5
Q

Pathophysiology of Acute osteomyelitis

A

Organism reach metaphysis: <24 hours
Systemic manifestations: Fever, pain
Abscess formed: After 24 hours

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6
Q

Reasons for Metaphyseal involvement
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A

Most vascular region of bone
Hairpin loop arrangement of blood vessels -> Sluggish blood flow
Less monocytes and macrophages

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7
Q

Pathophysiology of Chronic osteomyelitis

A

Sequestrum:
1. Dead bone formed
2. Hallmark of chronic osteomyelitis
Periosteal reaction: 10 days -> Involucrum (New bone forming around pathology)
Pus escapes through cloaca (Break in involucrum) and sinus (Break in skin)

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8
Q

Duration of each phase of Osteomyelitis

A

Acute: <2 weeks
Subacute: 2-4 weeks
Chronic: >4 weeks

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9
Q

Investigations of Acute Osteomyelitis

A

MRI: Picks up earliest changes within 24 hours of disease onset (Marrow edema)
Bone scan: Accumulation in infection
1. Technetium 99
2. Gallium 67
3. Indium III labelled WBC (Best)
X ray: Next card
Biopsy: Gold standard

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10
Q

X ray changes in Acute Osteomyelitis

A
  1. Changes detected after 24 hours of disease onset
  2. Earliest X ray change (within 48 hours): Soft tissue lucency/shadow around bone
  3. Earliest bony changes on X ray (7-10 days/2 weeks): Periosteal reaction
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11
Q

Treatment of Acute Osteomyelitis

A

Antibiotics: 2 weeks parenteral f/b 4 weeks oral
+/- Drainage of abscess

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12
Q

Complications of Acute Osteomyelitis

A
  1. Chronic osteomyelitis
  2. Septicemia
  3. Growth disturbance
  4. Septic arthritis
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13
Q

Features of Chronic osteomyelitis

A
  1. Sequelae/complication of acute osteomyelitis
  2. > 4 weeks foll infection
  3. Clinical hallmark: Sinus
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14
Q

Investigations of Chronic osteomyelitis

A

X ray/CT:
1. Loss of corticomedullary differentiation
2. Sequestrum
3. Involucrum
4. Cloaca

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15
Q

Treatment of Chronic osteomyelitis

A

Always surgical + antibiotic cover

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16
Q

Steps of surgery of chr osteomyelitis

A

Sinus tract excision -> Sequestrectomy -> Curettage till fresh blood seen (Paprika sign +ve) -> Saucerisation: Debridement to make the mouth wide -> Dead space closed with bone graft/cement

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17
Q

Complications of Chronic Osteomyelitis

A
  1. Pathological fracture (M/C): D/t weakened bone
  2. Acute exacerbation
  3. Squamous cell carcinoma: D/t neoplastic changes of sinus tract
  4. Amyloidosis
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18
Q

What is Subacute osteomyelitis?

A

No sinus or sequestrum (AKA Brodie’s abscess)

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19
Q

Pathogenesis of Subacute Osteomyelitis

A
  1. Patient has good immunity
  2. Organism has low virulence
    Infection contained
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20
Q

M/C site of Brodie’s abscess

A

Tibia (Proximal end)

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21
Q

C/F of Brodie’s abscess

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A
  1. Acute dull aching pain
  2. Low grade fever
22
Q

Radiological feature of Brodie’s abscess

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A

X ray/MRI:
Penumbra sign: Central lucency surrounded by dense sclerotic rim

23
Q

Treatment of Brodie’s abscess

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A

Antibiotics +/- Debridement

24
Q

What is Septic Arthritis?

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A

Surgical emergency:
If pus not removed from joint immediately -> Destruction of joint

25
M/C route of Septic Arthritis
Hematogenous
26
Sites of Septic arthritis
M/C site: Knee (Ends of bone exposed) Infants: Hip (Tom Smith’s arthritis)
27
Organisms causing Septic arthritis
M/C: Staph aureus IV drug abusers: Pseudomonas Sexually active: Gonococcus
28
C/F of Septic arthritis
Young child presents with: 1. High grade fever 2. Local inflammatory features: > Swelling > Redness > Pain (Joint effusion stretches pain sensitive capsule) > No movement at joint 3. Joint in position of ease -> Inc in joint volume -> Dec in pain
29
Treatment of Septic arthritis
Arthrotomy: Irrigation and Debridement of septic joint contents under antibiotic cover
30
What is Bony ankylosis?
End sequelae of neglected septic arthritis
31
How does Bony ankylosis occur?
Organisms release proteolytic enzymes: Collagenases, metalloproteinases, elastases | V Destroy articular cartilage | V Raw ends of bone exposed | V Heal with fusion | V Bony ankylosis
32
Types of Ankylosis
1. Bony ankylosis 2. Fibrous ankylosis
33
Causes of Ankylosis
Bony: 1. Pyogenic septic arthritis 2. TB spine (Spondylitis) Fibrous: TB arthritis
34
Fusion between raw ends of bone in diff ankylosis
Bony: Bone Fibrous: Fibrous tissue
35
Stability of joint in diff ankylosis
Bony: Stable Fibrous: Unstable
36
What is Tom Smith’s arthritis?
Septic arthritis of hip in infancy (<1 year)
37
C/F of Tom Smith’s arthritis
1. Hyper mobility of hip joint -> Telescopy test +ve 2. Limb shortening
38
M/C site of musculoskeletal system where TB infects
Spine TB spondylitis > Hip TB arthritis > Knee arthritis
39
M/C site in spine where TB infects
Dorsolumbar > Dorsal > Lumbar (In children: Cervical spine)
40
Variants of TB in ortho
Caries sicca: TB shoulder (Dry/non-exudative TB) Spina ventosa: TB fingers (Filling up of air appearance)
41
Patterns of involvement in TB Spine
1. Paradiscal (M/C) 2. Central 3. Anterior/wet/exudative (In children) 4. Posterior (Rarest)
42
TB spine vs Spine metastasis on MRI
Disc involved (Bad disc): TB spine (Good prognosis) Disc spared (Good disc): Metastasis (Bad prognosis)
43
Local findings of TB spine
1. Back pain (Earliest symptom) 2. Paraspinal spasm/tenderness (Earliest sign): Military attitude, cautious gait 3. Cold abscess 4. Deformity (D/t vertebral collapse)
44
Spinous process felt prominently on palpation
Knuckle: Prominence of 1 spinous process Gibbus: Prominence of 2-3 spinous process Angular kyphosis: Prominence of >3 spinous process
45
X ray features of TB spine
1. Disc space narrowing (D/t destruction/dessication of disc): Earliest 2. Para vertebral abscess 3. Vertebral destruction
46
MRI features of TB spine
1. Disc involved 2. Paradiscal disease involving bone and cartilage (CT guided biopsy: Gold standard)
47
Complication of TB spine
Pott’s paraplegia
48
What is Pott’s paraplegia?
TB spine (Pott’s spine) -> Compresses on spinal cord -> Neurolocal signs
49
C/F of Pott’s paraplegia
Early neurological manifestations (UMN findings) Late: Bowel and bladder involvement
50
Treatment of TB spine
ATT for 18-24 months + rest + Taylor’s brace Improvement: Continue treatment No improvement: Surgical decompression
51
Limping child D/D Just study
Fever +: Septic arthritis No fever: Perthe’s disease

Orthopaedics (12 decks)

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