Osteomyelitis

Question 1

what is osteomyelitis?

Answer 1

inflammation of the bone due to an infection

Question 2

what is the most common cause of osteomyelitis?

Answer 2

staph aureus

Question 3

what is the most common cause of osteomyelitis in people with sickle cell anaemia?

Answer 3

salmonella

Question 4

how can osteomyelitis occur?

Answer 4

haematogenous (originating from bacteria in the blood)

contiguous (originating from a focus of infection adjacent to the area of osteomyelitis)

Question 5

what is the common final pathophysiology of osteomyelitis?

Answer 5

compromised soft-tissue envelope surrounding dead, infected and reactive new bone

Question 6

what can cause osteomyelitis?

Answer 6

trauma
surgery
presence of foreign bodies
prosthesis 
haematogenous spread after bacteraemia

Question 7

how does osteomyelitis present?

Answer 7

fever, chills, fatigue, lethargy
local pain
swelling
redness
nausea
warmth in the area
loss of range of motion

Question 8

what may be noted on examination of osteomyelitis?

Answer 8

scars or local disturbances of wound healing
signs of inflammation
reduced range of motion
deformity
local signs of impaired vascularity
point tenderness (if periosteal tissues involved)

Question 9

what are the risk factors for osteomyelitis?

Answer 9

diabetes
sickle cell disease
HIV/AIDS
RA
IV drug use
alcoholism
long term steroid us
haemodialysis
poor blood supply
recent injury
bone surgery/prosthesis
open fracture

Question 10

how is osteomyelitis diagnosed?

Answer 10

bone biopsy
blood tests (CRP, FBC etc)
X Rays, MRI

Question 11

where does osteomyelitis most commonly occur in children?

Answer 11

metaphysis of long bones

Question 12

what is the section of separated dead, infected bone which is wrapped in new bone called?

Answer 12

sequestrum

Question 13

list 3 complications of osteomyelitis

Answer 13

inflammation can affect the periosteum
- periosteum is only loosely attached to the compact bone so can lift off allowing an abscess to form between the periosteum and the bone
- this abscess/infection can track along the periosteum and lift it off from the bone
infection can spread to:
- nearby joints
- muscle
- skin
- blood vessels (leading to thrombophlebitis)

Question 14

what does an X ray show in osteomyelitis?

Answer 14

thickening of cortical bone and periosteum
elevation of periosteum
loss of normal architecture
osteopenia

Question 15

how is osteomyelitis managed?

Answer 15

6 weeks of antibiotics

surgery to remove necrotic bone/sequestrum