FRCS Paediatric Ortho — improved notes
FRCS Paediatric Ortho — visual inline notes
← Previous
Slide 49 / 144
←/→ nav · S image · T theme · +/− font
Next →

049. Acute osteomyelitis

visual-inline rebuild1 extracted figuresspeaker notes XML43 study lines5 Q&A

Individual slide images have been cropped from the rendered slide and inserted beside the matching note section. The full slide remains below only for layout/audit.

Clean FRCS notes with inline figures

Acute osteomyelitis

•Ddx tumour

XR comment on any sequestrum / involucrum

Radiograph / imaging
Fig 1. Radiograph / imagingtop left

Pathophysiology

•Hematological spread
•Bacteria adhere and proliferate in metaphyseal region (hair pin turn with sluggish flow, low oxygen tension, acidic)
•Pus formation, drain along Haversian canal and Volkmann canal
•Break out as subperiosteal abscess
•high intra osseous pressure + poor blood supply due to elevated periosteum → bone ischemia (blood vessel thrombosis)→ Sequestrum
•Subperiosteal new bone formation → Involucrum
•Pus break through involucrum → Cloaca
•In neonate (<1.5yo, with patent transphyseal artery) or in intraarticular epiphysis (prox humerus, femur, radial head, distal fibular) → septic arthritis

Stages of acute osteomyelitis + DRAW

•Inflammation
•Suppuration
•Necrosis
•New bone formation
•Resolution

Common pathogens:

•Most common in all: Staph aureus
•Neonates: Group B strep, Hemophilus Influenza
•1-16 y.o.: strep pyogenes, Hemophilus influenza

Management

•Hx + PE (PMHx, recent injury, FtT, refuse walking, other source of infection)
•Common bacteria (staph, strep B and gram –ve rod in infant, MRSA)

Investigations

•blood (WBC CRP ESR, C/ST)
•Xray: 1st week XR normal, 1 week periosteal reaction, 2 week lytic lesion (metaphyseal rarefaction)
•MRI: early Dx, drainable abscess
•Bone scan: Indium / Technetium + gallium
•+/- Image guided aspiration

Indication of surgery:

•No systemic response to antibiotic for 48hrs (fever down, drop CRP)
•Drainable abscess
•Subperiosteal abscess: Incise periosteum and drainage
•Intramedullary abscess: Drill holes over metaphysis for IM release

Complication

•Chronic osteomyelitis (5%)
•LLD (over / undergrowth, arthritis, pathological #)
•30% will have concomitant septic arthritis
•→ Shoulder / elbow / hip/ ankle – intraarticular physis, spread to give septic arthritis
•→ Transphyseal vessels (disappear at 1.5yr of age) → septic arthritis

Direct Q&A

Q1 What pathophysiology is described for Acute osteomyelitis?

Hematological spread

•Bacteria adhere and proliferate in metaphyseal region (hair pin turn with sluggish flow, low oxygen tension, acidic)
•Pus formation, drain along Haversian canal and Volkmann canal
•Break out as subperiosteal abscess
•high intra osseous pressure + poor blood supply due to elevated periosteum → bone ischemia (blood vessel thrombosis)→ Sequestrum
•Subperiosteal new bone formation → Involucrum
•Pus break through involucrum → Cloaca
•In neonate (<1.5yo, with patent transphyseal artery) or in intraarticular epiphysis (prox humerus, femur, radial head, distal fibular) → septic arthritis
Q2 How is Acute osteomyelitis managed?
•Hx + PE (PMHx, recent injury, FtT, refuse walking, other source of infection)
•Common bacteria (staph, strep B and gram –ve rod in infant, MRSA)
Q3 What investigations are listed for Acute osteomyelitis?

blood (WBC CRP ESR, C/ST)

•Xray: 1st week XR normal, 1 week periosteal reaction, 2 week lytic lesion (metaphyseal rarefaction)
•MRI: early Dx, drainable abscess
•Bone scan: Indium / Technetium + gallium
•+/- Image guided aspiration
Q4 What operative steps, indications, and risks are listed for Indication of surgery?
•No systemic response to antibiotic for 48hrs (fever down, drop CRP)
•Drainable abscess
•Subperiosteal abscess: Incise periosteum and drainage
•Intramedullary abscess: Drill holes over metaphysis for IM release
Q5 What complications are listed for Acute osteomyelitis?
•Chronic osteomyelitis (5%)
•LLD (over / undergrowth, arthritis, pathological #)

Raw speaker-note hierarchy audit

#lvlmarLindentlogicaloriginal note line
10NoneNone0Acute osteomyelitis
20NoneNone0Ddx tumour
30NoneNone0XR comment on any sequestrum / involucrum
40NoneNone0Pathophysiology
50171450-1714501Hematological spread
60171450-1714501Bacteria adhere and proliferate in metaphyseal region (hair pin turn with sluggish flow, low oxygen tension, acidic)
70171450-1714501Pus formation, drain along Haversian canal and Volkmann canal
80171450-1714501Break out as subperiosteal abscess
90171450-1714501high intra osseous pressure + poor blood supply due to elevated periosteum → bone ischemia (blood vessel thrombosis)→ Sequestrum
100171450-1714501Subperiosteal new bone formation → Involucrum
110171450-1714501Pus break through involucrum → Cloaca
120171450-1714501In neonate (<1.5yo, with patent transphyseal artery) or in intraarticular epiphysis (prox humerus, femur, radial head, distal fibular) → septic arthritis
130000Stages of acute osteomyelitis + DRAW
141685800-2286002Inflammation
151685800-2286002Suppuration
161685800-2286002Necrosis
171685800-2286002New bone formation
181685800-2286002Resolution
190000Common pathogens:
200000Most common in all: Staph aureus
210000Neonates: Group B strep, Hemophilus Influenza
2200001-16 y.o.: strep pyogenes, Hemophilus influenza
230NoneNone0Mx:
240NoneNone0Hx + PE (PMHx, recent injury, FtT, refuse walking, other source of infection)
250NoneNone0Common bacteria (staph, strep B and gram –ve rod in infant, MRSA)
260NoneNone0Ix:
270171450-1714501blood (WBC CRP ESR, C/ST)
280171450-1714501Xray: 1st week XR normal, 1 week periosteal reaction, 2 week lytic lesion (metaphyseal rarefaction)
290171450-1714501MRI: early Dx, drainable abscess
300171450-1714501Bone scan: Indium / Technetium + gallium
310171450-1714501+/- Image guided aspiration
320NoneNone0Indication of surgery:
330171450-1714501No systemic response to antibiotic for 48hrs (fever down, drop CRP)
340171450-1714501Drainable abscess
350000Subperiosteal abscess: Incise periosteum and drainage
360000Intramedullary abscess: Drill holes over metaphysis for IM release
370NoneNone0Complication
380171450-1714501Chronic osteomyelitis (5%)
390171450-1714501LLD (over / undergrowth, arthritis, pathological #)
400000==========
41000030% will have concomitant septic arthritis
420000→ Shoulder / elbow / hip/ ankle – intraarticular physis, spread to give septic arthritis
430000→ Transphyseal vessels (disappear at 1.5yr of age) → septic arthritis

Improved semantic hierarchy used for the study notes

#semantic levelsection?rewritten line
10yesAcute osteomyelitis
21Ddx tumour
30yesXR comment on any sequestrum / involucrum
40yesPathophysiology
51Hematological spread
61Bacteria adhere and proliferate in metaphyseal region (hair pin turn with sluggish flow, low oxygen tension, acidic)
71Pus formation, drain along Haversian canal and Volkmann canal
81Break out as subperiosteal abscess
91high intra osseous pressure + poor blood supply due to elevated periosteum → bone ischemia (blood vessel thrombosis)→ Sequestrum
101Subperiosteal new bone formation → Involucrum
111Pus break through involucrum → Cloaca
121In neonate (<1.5yo, with patent transphyseal artery) or in intraarticular epiphysis (prox humerus, femur, radial head, distal fibular) → septic arthritis
130yesStages of acute osteomyelitis + DRAW
142Inflammation
152Suppuration
162Necrosis
172New bone formation
182Resolution
190yesCommon pathogens:
201Most common in all: Staph aureus
211Neonates: Group B strep, Hemophilus Influenza
2211-16 y.o.: strep pyogenes, Hemophilus influenza
230yesManagement
241Hx + PE (PMHx, recent injury, FtT, refuse walking, other source of infection)
251Common bacteria (staph, strep B and gram –ve rod in infant, MRSA)
260yesInvestigations
271blood (WBC CRP ESR, C/ST)
281Xray: 1st week XR normal, 1 week periosteal reaction, 2 week lytic lesion (metaphyseal rarefaction)
291MRI: early Dx, drainable abscess
301Bone scan: Indium / Technetium + gallium
311+/- Image guided aspiration
320yesIndication of surgery:
331No systemic response to antibiotic for 48hrs (fever down, drop CRP)
341Drainable abscess
351Subperiosteal abscess: Incise periosteum and drainage
361Intramedullary abscess: Drill holes over metaphysis for IM release
370yesComplication
381Chronic osteomyelitis (5%)
391LLD (over / undergrowth, arthritis, pathological #)
400——
41130% will have concomitant septic arthritis
421→ Shoulder / elbow / hip/ ankle – intraarticular physis, spread to give septic arthritis
431→ Transphyseal vessels (disappear at 1.5yr of age) → septic arthritis
← PreviousIndexNext →