Osteomyelitis

Question 1

What is the definition of osteomyelitis?

Answer 1

Acute inflammation of the bone caused by a bacterial infection.

Question 2

Where does osteomyelitis commonly occur in children?

Answer 2

• arms, legs, hips, shoulders, wrists

Question 3

Where does osteomyelitis commonly occur in adults?

Answer 3

• spine, feet, pelvis

Question 4

What are the most common causes of osteomyelitis?

Answer 4

• blood borne infection secondary to respiratory/renal/UTI
• cellulitis
• open wound over a bone

Question 5

What are the predisposing factors for osteomyelitis?

Answer 5

• PVD
• Peripheral Neuropathy
• Diabetes
• Open #
• Surgery/injection
• Orthopaedic/dental
• Immuno-suppressed

Question 6

What are the signs and symptoms of osteomyelitis?

Answer 6

• fever/irritability/fatigue
• nausea
• tenderness/swelling
• loss of ROM if near a joint

Question 7

Treatment for osteomyelitis is based on…

Answer 7

• causative agent/bacteria
• route by which infection reached the bone
• duration of infection
• local and systemic factors

Question 8

What is the pathogenesis of osteomyelitis?

Answer 8

Bacteria hides in osteoblasts - secretes pus - spreads to vascular channels - impairs blood flow - acute becomes chronic infection - ischaemic necrosis of bone (no living osteocytes)

Question 9

What are the types of osteomyelitis?

Answer 9

• Acute hematogenous
• Secondary osteomyelitis
• Sub-acute
• Chronic development

Question 10

What is acute hematogenous osteomyelitis?

Answer 10

• infection arises in blood
• predominantly in children
• commonly in metaphysis of long bones
• commonly in the spine in adults and in IV drug users
• usually history of blunt trauma that has created a haematoma

Question 11

What are the symptoms of acute hematogenous osteomyelitis?

Answer 11

• fever
• chills
• localized pain/tenderness
• decreased ROM/ability to WB
• erythema

Question 12

What is secondary contiguous osteomyelitis?

Answer 12

• secondary to contiguous infection
• common in adults
• usually secondary to an open wound
• other causes include bites, open #, surgical procedures or foreign bodies
• diagnosis not usually made until chronic infection present and sinus present

Question 13

Risk of chronic osteomyelitis is increased in those with…

Answer 13

• PVD
• Diabetes
• decreased neurovasc status
• infection
• poor healing due to poor tissue perfusion
• frequent trauma due to neuropathy

Question 14

How is osteomyelitis diagnosed?

Answer 14

• PROBE TO BONE
• clinical findings (subjective and objective)
• lab tests
• x-rays, MRI and CT
• histopathologic and microbiologic assessment (GOLD STANDARD)

Question 15

What is chronic suppurative osteomyelitis?

Answer 15

• a complication of chronic osteomyelitis
• the necrotic bone forms a sequestrum of dead bone that spurs on the infection
• multiple sinuses can occur

Question 16

Is acute hematogenous osteomyelitis polymicrobial?

Answer 16

No, it is usually infected by a single organism. Most common is staph aureus. Secondary contiguous infection is more likely to be polymicrobial.

Question 17

Treatment of osteomyelitis involves…

Answer 17

• antimicrobial management (oral or IV antibiotics)
• surgical debridement
• drainage of pus
• stabilization of bone
• amputation
• chronic wound management

Question 18

What type of benign bone tumours are there?

Answer 18

• osteochondroma
• osteoblastoma
• osteoid osteoma
• giant cell tumour

Question 19

Describe osteochondroma.

Answer 19

• contains cartilage and bone

- common to growth plates of long bones

Question 20

Describe osteoblastoma.

Answer 20

• solitary bone neoplasm
• common to vertebrae of children and young adults
• short and flat bones are most affected

Question 21

Describe osteoid osteoma.

Answer 21

• benign osteoblastic tumour of unknown aetiology

- most often in long bones

Question 22

Describe giant cell tumour.

Answer 22

• most common of benign tumours

Question 23

What is the treatment for benign bone tumours?

Answer 23

• surgery

- monitor

Question 24

What is a primary malignant lesion?

Answer 24

• originated in bone

- bone cells that become cancerous then spread through the bloodstream to other sites

Question 25

What is a secondary malignant lesion?

Answer 25

- cancerous cells from another site (e.g. breast) spread through the bloodstream and infiltrate the bone

Question 26

Describe osteosarcoma.

Answer 26

- most common type of primary malignant bone tumours - usually in metaphysical regions of long bones - penetrates and destroys bone cortex and extend to surrounding tissue

Question 27

What are the symptoms of osteosarcoma?

Answer 27

- frequent pain in areas - swelling - decreased ROM

Question 28

Describe Ewing's Sarcoma.

Answer 28

- primary malignant bone tumour - common in teenagers - common in pelvis, hips, femur or tibia - can sometimes see in soft tissue

Question 29

Describe chondrosarcoma.

Answer 29

- primary malignant bone tumour - relatively rare - cancer of the cartilage cells - common in pelvis, femur, humorous and ribs - adults over 40

Question 30

Describe multiple myeloma.

Answer 30

- a plasma cell tumour that can interfere with the production of blood cells - plasma cell proliferation causes skeletal destruction - plasmacytomas (accumulate in bone or soft tissue) - easily misdiagnosed as back pain in early stages

Question 31

What are the symptoms of multiple myeloma?

Answer 31

- bone pain - persistant infection - anaemia - renal impairment - back pain/pathological # - symptoms of spinal cord or nerve root compression

Question 32

What is the treatment and prognosis of multiple myeloma?

Answer 32

- no cure just symptoms control | - survival is 1-10 years with a average of 3 years

Question 33

What is osteoporosis?

Answer 33

Insufficient bone formation or excessive bone reabsorption. Bone becomes brittle and fragile. Bone loses minerals faster than it can replace.

Question 34

What is osteomalacia?

Answer 34

- impairment of bone mineralization usually due to vitamin D - due to reduced sunlight or digestive kidney disease - bone reabsorption is faster than bone reformation

Question 35

What is Paget's Disease?

Answer 35

- accelerated skeletal remodelling - generally affects long bones and leads to enlarged bones and makes them spongy - unknown aetiology

Question 36

What are the symptoms of Paget's Disease?

Answer 36

- pain - bone deformity - # - arthritis

Question 37

How is Paget's Disease diagnosed?

Answer 37

- x-ray | - alkaline phosphatase test

Question 38

What is osteochondritis dissecans?

Answer 38

- affects adolescents and young adults, commonly males - spontaneous loss of blood supply to bone and adjacent cartilage - symptoms include joint pain and loss of ROM - treated with surgical removal

Question 39

What is osteogenesis imperfecta?

Answer 39

- genetic disorder - mutation of COL1A1 and COL1A2 gene - increased bone fragility, low bone mass, connective tissue problems - associated with blue sclera, hearing loss, hyper laxity of ligaments, spinal curvature, triangular face, muscle weakness

Question 40

What is the treatment of osteogenesis imperfecta?

Answer 40

- physiotherapy - surgery - braces - orthoses