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Questions and Answers
What is the primary mechanism of joint inflammation in syptic arthritis?
What is the primary mechanism of joint inflammation in syptic arthritis?
- Bacterial seeding (correct)
- Chemical irritation
- Viral infection
- Autoimmune response
Which of the following joints is most commonly affected by syptic arthritis?
Which of the following joints is most commonly affected by syptic arthritis?
- Ankle
- Elbow
- Wrist
- Knee (correct)
What is considered the gold standard for diagnosing syptic arthritis?
What is considered the gold standard for diagnosing syptic arthritis?
- Joint aspiration culture (correct)
- CBC
- X-ray
- MRI
Which organism is most commonly associated with syptic arthritis cases?
Which organism is most commonly associated with syptic arthritis cases?
What laboratory examination result is most indicative of inflammation in syptic arthritis?
What laboratory examination result is most indicative of inflammation in syptic arthritis?
Which of the following is NOT a common risk factor for developing syptic arthritis?
Which of the following is NOT a common risk factor for developing syptic arthritis?
What is the initial treatment approach for syptic arthritis?
What is the initial treatment approach for syptic arthritis?
Which symptom is least likely to be associated with syptic arthritis?
Which symptom is least likely to be associated with syptic arthritis?
What is the major characteristic of osteomyelitis in its pathophysiology?
What is the major characteristic of osteomyelitis in its pathophysiology?
Which of the following is NOT a risk factor for osteomyelitis?
Which of the following is NOT a risk factor for osteomyelitis?
In which anatomical type does osteomyelitis primarily affect the medullary cavity of bones?
In which anatomical type does osteomyelitis primarily affect the medullary cavity of bones?
What is stage II of osteomyelitis characterized by?
What is stage II of osteomyelitis characterized by?
What does the Cierny Mader Type C classification indicate about a patient's condition?
What does the Cierny Mader Type C classification indicate about a patient's condition?
Which spread mechanism of osteomyelitis is commonly seen in children?
Which spread mechanism of osteomyelitis is commonly seen in children?
What type of surgical outcome is anticipated for a Type B patient under Cierny Mader classification?
What type of surgical outcome is anticipated for a Type B patient under Cierny Mader classification?
Which type of osteomyelitis reflects an extensive and diffuse bacterial infection?
Which type of osteomyelitis reflects an extensive and diffuse bacterial infection?
What primary imaging finding is associated with chronic osteomyelitis after 6 weeks?
What primary imaging finding is associated with chronic osteomyelitis after 6 weeks?
Which lab examination result is most indicative of osteomyelitis?
Which lab examination result is most indicative of osteomyelitis?
What is the standard method for diagnosing osteomyelitis?
What is the standard method for diagnosing osteomyelitis?
What type of surgical procedure may be performed after 6 weeks of aggressive debridement if the infection persists?
What type of surgical procedure may be performed after 6 weeks of aggressive debridement if the infection persists?
Which statement about the Gallium bone scan is accurate?
Which statement about the Gallium bone scan is accurate?
In the treatment of infected metal implants, which approach is appropriate if the implants are unstable?
In the treatment of infected metal implants, which approach is appropriate if the implants are unstable?
Which of the following best describes the term 'involucrum'?
Which of the following best describes the term 'involucrum'?
What is the appropriate antibiotic regimen for treating osteomyelitis?
What is the appropriate antibiotic regimen for treating osteomyelitis?
Flashcards
Septic Arthritis
Septic Arthritis
An inflammation of joints caused by infection, commonly affecting the knee, hip and shoulder.
How is Septic Arthritis caused?
How is Septic Arthritis caused?
An inflammation of joints caused by bacteria entering the joint space.
Bacteremia (hematogenous spread)
Bacteremia (hematogenous spread)
The most common cause in children, where bacteria travel through the bloodstream to the joint.
Direct Infection (Septic Arthritis)
Direct Infection (Septic Arthritis)
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Contagious spread
Contagious spread
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Joint Aspiration Culture
Joint Aspiration Culture
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Persistent Joint Pain
Persistent Joint Pain
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Drainage of Infected Joint
Drainage of Infected Joint
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Osteomyelitis
Osteomyelitis
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Hematogenous spread
Hematogenous spread
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Planktonic stage
Planktonic stage
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Biofilm formation
Biofilm formation
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Cierny-Mader Classification
Cierny-Mader Classification
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Type A (Cierny-Mader)
Type A (Cierny-Mader)
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Type B (Cierny-Mader)
Type B (Cierny-Mader)
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Sequestrum
Sequestrum
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Involucrum
Involucrum
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Gallium Bone Scan
Gallium Bone Scan
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Bone Culture
Bone Culture
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Radical Debridement & Irrigation
Radical Debridement & Irrigation
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Metal Implant Removal & External Fixators
Metal Implant Removal & External Fixators
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Intramedullary Nail Fixation & Bone Cement
Intramedullary Nail Fixation & Bone Cement
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Antibiotic Treatment
Antibiotic Treatment
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Study Notes
Septic Arthritis
- Septic arthritis is inflammation of joints due to infection.
- It can affect any joint, but the knee (50%) is most common, followed by the hip and shoulder.
- Risk factors:
- Old age
- Diabetes
- Rheumatoid arthritis (RA)
- Liver cirrhosis
- HIV
Pathophysiology
- Primarily caused by bacterial seeding of the joint.
- Three causes of bacterial seeding:
- Bacteraemia (or hematogenous spread): most common in children.
- Direct infection (e.g., trauma, surgery).
- Contagious spread (through the bone marrow).
- Bacteria reaching the joint release proteolytic enzymes, leading to cartilage destruction.
- Staphylococcus aureus is the most common pathogen.
Presentation
- Joint pain: Persistent, not relieved by pain medication, and not aggravated by activity.
- Toxic appearance (less common).
- Fever (rare).
- Redness (erythema).
- Swelling (joint effusion).
- Tenderness around the joint.
- Restricted range of motion (ROM).
- Inability to bear weight.
Investigations
- X-ray and MRI are not highly sensitive.
- Musculoskeletal ultrasound may be helpful.
- Gold standard: Sample aspiration culture or aspiration biopsy.
- Culture sensitivity testing is essential to identify the organism and guide antibiotic treatment.
- Guided aspiration biopsy is an alternative method using imaging like US or CT.
- Sinus discharge pus is a sign of infection.
Lab Examinations
- Elevated erythrocyte sedimentation rate (ESR) (> 30 mm/h)
- Elevated C-reactive protein (CRP) (>10 mg/dL)
- Complete blood count (CBC): Leukocytosis (increased white blood cells) with a left shift (increase in immature cells).
- Joint aspiration: WBC count > 50,000
- Increased number of macrophages and inflammatory markers.
Treatment
- Drainage:
- Arthroscopic arthrotomy (for knee)
- Open arthrotomy (for hip)
- Debridement and lavage
- Antibiotics: Intravenous (IV) for at least 2 weeks, followed by oral antibiotics for 4 weeks.
- ESR and CRP are monitored for follow-up.
Complications
- Osteoarthritis (OA)
- Osteomyelitis
- Joint deformity
Osteomyelitis
- Infection of bone, characterized by progressive inflammatory destruction and apposition of new bone.
- Risk factors: Trauma or post-surgery, immunodeficiency disease, diabetes, smoking, and peripheral vascular disorders.
- Pathophysiology:
- Hematogenous spread (common in children)
- Contiguous spread
- Direct spread
Classification of Septic Arthritis
-
1-Anatomical type
- Stage I: Medullary
- Stage II: Superficial
- Stage III: Localized
- Stage IV: Diffuse
-
2-Host Type
- Type A: Normal host
- Type B: Local or systemic compromises
- Type C: High risk and unfit for surgery (due to other illnesses)
Additional Notes
- If a metal implant is loose or unstable, the implant must be removed, and external fixators used until full elimination of infection.
- The second stage of surgical treatment involves internal fixation by nail and manage the dead bone space by bone graft.
- Follow-up treatment with antibiotics is required for a period of 6 weeks, divided into 2 weeks of IV antibiotics and 4 weeks of oral antibiotics.
- If infection is chronic / neglected, pus might be found.
- Key investigative tools are X-ray, MRI and gallium bone scan.
- Bone Scan (Gallium) - Radioactive material that is highly sensitive to infection, appearing as "hot spots" on the image.
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Description
This quiz covers septic arthritis, including its causes, risk factors, and clinical presentation. Learn about the pathophysiology, common pathogens, and key symptoms associated with this infection-related joint disease.
