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31 Cards in this Set

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When is an infection of the soft tissue called?
Cellulitis
What is an infection of the bone called?
Osteomyelitis
What is an infection of the joint called?
Septic or pyogenic arthritis
What need to be present for an infection to occur?
Host
Pathogen
Immune response
Damage to host tissue
How is Osteomyelitis classified?
According to the Cierney-Mader classification. It is based on the anatomical(medullary, superficial, localized, diffuse) and physiological (host is either normal, compromised, or the treatment will be worse then the disease) characteristics of the patient.
What are the categories of osteomyelitis?
Can follow hematogenous spread, be secondary to a contigous force, or be associated with vascular insuffiency.
What occurs during acute hematogenous osteomyelitis?
The bacteria seeds the bone from a distant site.
Who is hematogenous osteomyelitis most often seen in?
Very young patients, older adults, and IV drug abusers.

Can also be seen in patients with sickle cell disease and patients on hemodialysis.
Where is the most common site of acute hematogenous osteomyelitis in children? In adults?
In children it is mainly seen in the long bones particularly around the growth plate. In adults it is usually seen in the thoracic or lumbar vertebrae.
What are the signs and symptoms of acute hematogenous osteomyelitis?
Pain on ambulation

Localized tenderness/swelling

Fever/chills/night sweats

Malaise
What laboratory values are associated with acute hematogenous osteomyelitis?
Elevated WBC

Blood cultures +

Elevated ESR/CRP
What is the current treatment for acute hematogenous osteomyelitis?
IV-antibiotic for two weeks followed by a PO-antibiotic for 2-3 months
Why has the incidence of vertebral osteomyelitis increased in recent years?
Increasing rates of nosocomial bacteremia due to intravascular devices and other forms of instrumentation.

Increasing age of the population

Increasing IV drug abuse
What patients are typically affected by vertebral OM?
Primarily adults with most patients being older then 50 yrs and men being affected twice as often as women.
Contiguous focus OM is a direct extension of:
Postoperative infections
Puncture wounds
Bite wounds
Ulcerations/lacerations
Open fxs
Septic arthritis
How does contiguous focus OM present clinically?
Local signs of infection
Fever
Draining sinus
Radiographs show signs
Bone may be probed
What is the technique used when probing to bone?
Use a stainless steel blunt probe

Hold it like a pencil

Explore gently via path of least resistence

Feel for hard or gritty structure without intervening soft tissue
What lab findings are associated with contiguous focus OM?
WBC frequently normal
ESR nonspecific
Blood culture rarely helpful
Superficial culture not helpful
Bone culture definitive
What is the treatment for contiguous focus OM?
Initial surgical debridement

Appropriate post-op wound care

Parentereal antibiotics for 4-6 weeks

Definitive debridement if needed
What are the three main causes of vascular insuffiency OM?
Arteriosclerosis
DM w/ arterial disease
Frostbite
What is vascular insuffiency OM?
Occurs when the bone becomes infected in the face of ischemic soft tissue. Occurs mainly in the lower extremities.
What is the clinical presentation of vascular insuffiency OM?
Muted or absent inflammatory response

Gangrenous changes

Ischemic pain

Seen commonly in the forefoot
What are the lab findings when vascular insuffiency OM is present?
Blood results likely to be falsely negative or muted

Noninvasive vascular studies may show decreased perfusion

Invasive vascular studies will show decreased perfusion
What is the bacterial etiology of vascular insuffienciency OM?
Polymicrobial in nature

Gram negative and gram postive aerobes found

Anaerobes are seen when frank skin necrosis is present
What is the treatment for vascular insufficiency OM?
Address ischemia first

Vascular consult

Removal of non-viable tissue as appropriate

Allow auto-amputation

Antibiotics to prevent spread
What are the two types of septic arthritis?
Hematogenous and direct inoculation
What are predisposing factors for hematogenous septic arthrtis?
RA
Immunosuppression
Previous trauma to joint
What are causes of direct inoculation septic arthritis?
Surgery/Arthroscopy
Puncture wounds
Animal bites
Intra-articular injections
Adjacent OM
What is the clinical presentation of septic arthritis?
Almost always monoarticular

See cardinal signs of infection and constitutional symptoms

Joint swelling

Limited and painful ROM w/ guarding

Plain films show increased soft tissue, only sometimes will bone changes be seen

Increased signal on MRI
What are the lab findings with septic arthritis?
Leukocytosis
Positive gram stain
Blood cultures may be +

A joint aspirate culture and synovial fluid analysis should also be performed.
What is the treatment for septic arthritis?
Aspiration
Repeat aspiration
Surgical drainage
Systemic antibiotics