Bone and Soft Tissue Infections Flashcards Preview

Systems: MSK AB > Bone and Soft Tissue Infections > Flashcards

Flashcards in Bone and Soft Tissue Infections Deck (54)
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31

What is the pathophysiology of chronic osteomyelitis/

-Cavities, poss. sinus(es)
-Dead bone (retained sequestra)
-Involucrum
-Histological picture is one of chronic inflammation

32

What are the possible complications of chronic osteomyelitis?

-Chronically discharging sinus + flare-ups
-Ongoing (metastatic) infection (abscesses)
-Pathological fracture
-Growth disturbance + deformities
-Squamous cell carcinoma (0.07%)

33

What are the treatment options for chronic osteomyelitis?

Long-term antibiotics?(either local (gentamicin cement/beads, collatamp) or systemic (orally/ IV/ home AB))
-Eradicate bone infection- surgically (multiple operations)
-Treat soft tissue problems
-Deformity correction?
-Massive reconstruction?
-Amputation?

34

What are the possible routes of infection in acute septic arthritis?

-Haematogenous
-eruption of bone abscess
-Direct invasion (penetrating wound, intra-articular injury, arthroscopy)

35

What are organisms are commonly implicated in acute septic arthritis?

-Staphylococcus aureus
-Haemophilus influenzae
-Streptococcus pyogenes
-E. coli

36

What is the pathophysiology behind acute septic arthritis?

-Acute synovitis with purulent joint effusion
-Articular cartilage attacked by bacterial toxin and cellular enzyme
-Complete destruction of the articular cartilage

37

What is the sequelae of acute septic arthritis?

Complete recovery
OR
Partial loss of the articular cartilage and subsequent OA
OR
Fibrous or bony anklyosis

38

How do neonates with acute septic arthritis often present?

Picture of septicaemia
-Irritability
-Resistant to movement
-Ill

39

How do children and adults often present with acute septic arthritis?

Acute pain in single large joint
-Reluctant to move the joint (any movement – c.f. bursitis where RoM OK)
-Increase temp. and pulse
-Increase tenderness

40

What is important to note about adults with septic arthritis?

-Often involves superficial joint (knee, ankle, wrist)
-Rare in healthy adult
-May be delayed diagnosis

41

How is acute septic arthritis investigated?

-FBC, WBC, ESR, CRP, blood cultures
-X ray
-Ultrasound
-Aspiration

42

What is the most common cause of septic arthritis in adults?

Infected joint replacements

43

What is the most common organism implicated in infected joint replacements?

Staph aureus

44

What are the outcomes of an infected joint replacement?

-Death
-Amputation
-Removal of arthroplasty

45

What is the differential diagnosis for acute septic arthritis?

-Acute osteomyelitis
-Trauma
-Irritable joint
-Haemophilia
-Rheumatic fever
-Gout
-Gaucher’s disease

46

How is acute septic arthritis treated?

-General supportive measures
-Antibiotics (3-4 weeks)
-Surgical drainage & lavage -

47

How is bone tuberculosis classified?

-Extra-articular (epiphyseal / bones with haemodynamic marrow)
-intra-articular (large joints)
-Vertebral body

Multiple lesions in 1/3 of patients

48

What are the clinical features of bone tuberculosis?

-Insidious onset & general ill health
-Contact with TB
-Pain (esp. at night), swelling, loss of weight
-Low grade pyrexia
-Joint swelling
-Decrease ROM
-Ankylosis
-Deformity

49

What is the pathophysiology behind bone tuberculosis?

-Primary complex (in lung or the gut)
-Secondary spread
-Tuberculous granuloma
-Note the role of nutrition and other disease (HIV/AIDs)

50

How does spinal tuberculosis present?

-Little pain
-Present with abscess or kyphosis

51

How is bone tuberculosis diagnosed?

-Long history
-Involvement of single joint
-Marked thickening of the synovium
-Marked muscle wasting
-Periarticular osteoporosis

52

How is bone tuberculosis investigated?

-FBC, ESR
-Mantoux test
-Sputum/urine culture
-X-Ray (soft tissue swelling, periarticular osteopenia, articular space narrowing)
-Joint aspiration and biopsy (AAFB identified in 10-20%, culture + in 50% of cases)

53

What is the differential diagnosis for bone tuberculosis?

-Transient synovitis
-Monoarticular RA
-Haemorrhagic arthritis
-Pyogenic arthritis
-Tumour

54

How is bone tuberculosis treated?

Chemotherapy
-Rifampicin, ethambutol and isoniazid 8 weeks
-Rifampicin and isoniazid further 6-12 months

-Rest and splintage
-Operative drainage rarely necessary