Osteomyelitis

Question 1

ESSENCE

Answer 1

Inflammation in a bone and bone marrow, usually caused by bacterial infection

Question 2

What is haematogenous osteomyelitis

Answer 2

Pathogen carried through blood and seeded in the bone, most common mode of infection

Question 3

AETIOLOGY

Most common causative organism

Answer 3

Staph aureus

Question 4

AETIOLOGY

Risk factors

Answer 4

• Open fracture
• Orthopaedic operation
• Diabetes
• Peripheral arterial disease
• IV drug use
• Immunosuppresion

Question 5

CLINICAL FEATURES

Presentation

Answer 5

• Fever
• Pain and tenderness
• Erythema
• Swelling
• Generalised symptoms
  
  • Fever, lethargy, nausea and muscle aches

Question 6

INVESTIGATIONS

First choice

Answer 6

• X-ray
  
  • Often shows no change
• MRI scan
  
  • Best to establish diagnosis
• Blood tests
  
  • Raised inflammatory markers (WBC, CRP, ESR)
• Blood cultures
• Bone cultures

Question 7

What are signs on x-ray

Answer 7

• Periosteal reaction (changes to surface of bones)
• Localised osteopenia (thinning of bone)
• Destruction of areas of bone

Question 8

MANAGEMENT

General principles

Answer 8

• Combination of
  
  • Surgical debridement
  • Antibiotic therapy

Question 9

MANAGEMENT

Antibiotics for acute

Answer 9

• 6 weeks of flucloxacillin, possibly with rifampicin or fusidic acid added for first 2 weeks
• Alternatives
  
  • Clindamycin in penicillin allergy
  • Vancomycin or teicoplanin for MRSA

Question 10

MANAGEMENT

Antibiotics for chronic

Answer 10

3 months of antibiotics, same ones as for acute