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Osteomyelitis (Risk factors (Vascular disease, Immunocompromised, IVDU,…
Osteomyelitis
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Diagnosis
Examination
Musculoskeletal exam
Tender, warm, swelling, heat
Pain on movement
Antalgic gait
Investigations
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Bloods
FBC (raised WCC), CRP (raised)
U+Es, LFTs, blood cultures (+ve)
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Imaging
X-ray: acute OM will be initially normal, then hazy,
loss of bone density (changes seen 10-14d)
chronic OM will show thick, irregular bone
USS: periosteal bone elevation
MRI if X-ray unclear: shows infection (pus)
Radionucleotide scan: if site unclear
History
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SH
Living arrangements, school/occupation,
smoking, alcohol, drugs (IVDU)
PC/HPC
Fever, malasie, swollen hot red area,
difficulty mobilising if affecting lower limbs,
Any trauma or recent infection
Pathophysiology
Agent
Causative organism commonly S. aureus,
pseudomonas, E. Coli, streps
Uncommon causes salmonella, mycobacteria, fungi
Mechanism
Source of infection may be local (e.g. trauma)
or systemic from another source e.g. URTIInfection erodes the cortex, causing holes in the bone,
pus lifts periosteum off bone and can cause necrosis
of bony fragments; may get new bone formation
Often distal femur, proximal tibia
Management
Definitive
Medical
Abx
Indication: all patients
e.g. initial broad spec; use local guidelines
MOA: intial IV until CRP normalised then PO
Analgesia
Indication: pain
E.g. paracetamol, ibuprofen, codeine
Surgical
Aspiration/decompression
Indication: acute with complications, chronic OM
MOA: removal of pus and infective material,
splinting and then mobilisation
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