Discuss the basic epidemiology, presentation, investigation, management and prognosis of osteomyelitis

Question 1

What does a swollen limb with thickened/woody skin suggest?

Answer 1

chronic osteomyelitis

Question 2

What is the mechanism that underlies chronic osteomyelitis?

Answer 2

1. the infection remains within the bone as sequestrum (a piece of necrotic bone detached from the healthy tissue)
2. the infection can remain quiscent for a period of time, then flare up unexpectedly

Question 3

How is osteomyelitis most likely to spread in childhood/adolescence?

Answer 3

haematogenous spread of bacteria

Question 4

How is osteomyelitis more likely to spread in adults?

Answer 4

exogenous spread (direct inoculation) of bacteria

Question 5

What blood results will a patient with osteomyelitis have?

Answer 5

• raised WCC
• raised CRP/ESR

Question 6

What will happen if post-operative osteomyelitis is left untreated?

Answer 6

a sinus will occur

Question 7

What is osteomyelitis?

Answer 7

infection in bone

Question 8

How will a patient with osteomyelitis present? (6)

Answer 8

• pain
• fever
• loss of function
• limb will be tender to palpate
• erythematous
• possibly swollen

Question 9

When should you take microbiology specimens from a patient with suspected osteomyelitis?

Answer 9

prior to starting antibiotics

Question 10

How can you treat osteomyelitis surgically?

Answer 10

• drain abscess
• dead bone (sequestrum) removed

Question 11

What symptoms will a patient with post-trauma or post-surgery osteomyelitis present with?

Answer 11

• red, painful, inflamed wound
• postoperative pain persists/increases
• wound will continue to leak and eventually break down

Question 12

How do you treat osteomyelitis conservatively?

Answer 12

• analgesia
• splintage
• antibiotics

Question 13

True or false?

If a patient presents in A&E with acute osteomyelitis, you can expect to see features of lysis, periosteal elevation, and new bone formation on their x-ray

Answer 13

False

initial X ray is normal

this is after 10 days

Question 14

What investigations should you carry out on a patient you suspect has early osteomyelitis?

Answer 14

1. bone scan
2. white-cell labelled scan
3. MRI

Question 15

What are the three most common scenarios causing osteomyelitis?

Answer 15

1. post trauma osteomyelitis
2. post surgery osteomyelitis
3. acute haematogenous osteomyelitis