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33 Cards in this Set

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Which patient population is more susceptible to bone and oint infection?
More common in infants, elderly, and immunosuppressed. Risk factors are trauma HIV, Diabetes, RA, transplant and IVDA
Most common cause of bone/joint infection?
Hematogenous spread, followed by direct inoculation from trauma/surgery, could be a spread from a soft tissue injury.
How to bacteria get access to the joint for infection?
Bind to the articular surface and the neutrophilic response releases proteases and collagenases. There is an inhibition of GAG synthesis and the loss of the matrix leads to chondrocyte death. Mechanical stress, further damage.
Which bacteria are common for causing septic arthritis?
S. Aureus causes 60% of bacterial septic joints, MRSA is increasing. Gram negatives and pseudo are common for IVDA, Gonococcal infection common in young adults, and infants is GAS, GBS, E.Coli, maternal infection
Septic arthritis in kids less than five, most common bacteria?
Kingella kingae, h. flu, s. pneuomonia
Most common bacteria in kids over 5
S. aureus, GAS, S. pneumonia
Clinical symptoms for septic joint
Warm, edematous, erythematous, painful, loss of weightbearing and ROM. WBC>50,000.
Most common joints to become septic
Knee>hip>shoulder>ankle>wrist
Most common bacteria in kids over 5
S. aureus, GAS, S. pneumonia
Tx for septic joint
Empiric ABX, culture directed ABX, Drain abscess via needle aspiration
Clinical symptoms for septic joint
Warm, edematous, erythematous, painful, loss of weightbearing and ROM. WBC>50,000.
What is osteomyelitis?
Inflammation of the bone and marrow. Spreads hematogenously in children or via direct innoculation
Most common joints to become septic
Knee>hip>shoulder>ankle>wrist
What is the pathophysiology of childhood osteomyelitis?
Bacteria escapes and adheres to hypertrophic zone of physis, local disruption of blood vessels, proliferation of PMNs, spread into sot tissue into bones where metaphysis. Bone dies due to infarction.
Pathophysiology of septic joint
Bacteria bind to the articular surface, Neutrophillic response.
Release of Proteases
Collagenases which cause Inhibition of glycosaminoglycan synthesis
Matrix loss leads to chondrocyte death
-Mechanical stress
-Further damage
Tx for septic joint
Empiric ABX, culture directed ABX, Drain abscess via needle aspiration
What is osteomyelitis?
Inflammation of the bone and marrow. Spreads hematogenously in children or via direct innoculation
What is the pathophysiology of childhood osteomyelitis?
Bacteria escapes and adheres to hypertrophic zone of physis, local disruption of blood vessels, proliferation of PMNs, spread into sot tissue into bones where metaphysis. Bone dies due to infarction.
Pathophysiology of septic joint
Bacteria bind to the articular surface, Neutrophillic response.
Release of Proteases
Collagenases which cause Inhibition of glycosaminoglycan synthesis
Matrix loss leads to chondrocyte death
-Mechanical stress
-Further damage
How is osteomyelitis treated in kids?
Empiric ABX followed 4-6 weeks afterwards. Surgical debridement if there is a joint infection present, purulence on aspiration, radiographic metaphyseal sequestrum, or no clinical improvement after adequate abx.
How are labs used to diagnose osteomyelitis?
ESR, CRP, WBC, differential, aspiration of bone for kids. Sinus cultures are not predictive!!!
What are the two types of osteomyelitis?
superficial and medullary, can be either localized or diffuse.
What is the expectation of osteomyelitis treatment in a normal healthy patient?
Treatment can be pursued with the expectation that infection can be treated
What is the expectation of osteomyelitis treatment in a patient with a chronic disease?
Infection can be treated, but it may take more time, or involve co-morbidities.
What is the expectation of osteomyelitis treatment in an immunosuppressed patient?
Treatment might do more harm than help, goal is suppression.
How do you treat a chronic bone infection in a union?
Remove hardware, debride the abscess, and then treat with abx.
How do you treat chronic bone infection in a nonunion?
Treat the infection with abx and then treat the nonunion. stability will promote healing.
What are the qualifications of a chronic bone infection?
increased pain, new drainage, previous incision or surgery, elevated ESR, CRP (may have normal WBC,) need an adequate sample of deep cultures.
Qualifications for an acute bone infection?
Local wound issues, films normal, no systemic symptoms, labs may be elevated. ABX for treatment, may also require debridement.
How are soft tissue chronic infections treated?
If the tissues are adequate, wound closure after debridement is okay. If the tissues are not adequate, they require a flap or a plastics consult. ABX beads can be used after the dead space has been managed.
Cocaine effect on pupils
mydriasis=dilated pupils
How are infections in prosthetic joints treated?
Treat with local debridement for acute infections and still retain the implant. For chronic infections take out the implant, manage the dead space, and then consider reimplantation
Describe peri-prosthetic infections.
1% of all joints will be affected. Chronic infections can lead to sepsis and aseptic loosening. Bacteria adheres to the implants, but can be prevented with antibacterial prophylaxis for dental procedures and procedures that cause bacteremia.