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Bone and Joint Infections 09
Bone and Joint Infections 09
NOTES
BONE & JOINT INFECTIONS
LAB RESULTS
RISK FACTORS
▪ Blood tests
▪ Trauma/open fractures, diabetes/
▪ Needle aspiration: pathogen detection
atherosclerosis, orthopedic implants,
existing infection etc.
TREATMENT
COMPLICATIONS
▪ Chronic infections MEDICATIONS
▪ Bone fractures ▪ Before identifying pathogen → general
▪ Loss of mobility antibiotics
▪ Dissemination of infection ▪ Known pathogen → specific antibiotics
SURGERY
SIGNS & SYMPTOMS ▪ Surgical cleaning
▪ Pain → individual avoids using infected
joint
Systemic
▪ Fever, chills, weakness, headache
Local
▪ Swollen, painful, warm
OSMOSIS.ORG 587
OSTEOMYELITIS
osms.it/osteomyelitis
▪ Cortical loss
PATHOLOGY & CAUSES ▪ Contrast enhancement of abscess rim
▪ Bacterial infection (S. aureus, M. Nuclear medicine scans
tuberculosis most common) → bone, bone ▪ If MRI not attainable: higher radiotracer
marrow inflammation uptake
▪ Bacteria → bone via bloodstream, nearby
infection, open fractures/orthopedic CT scan, X-ray
implants ▪ not sensitive for 1–2 weeks
▪ First week: bacterial reproduction → ▫ Osteopenia (decreased bone density)
inflammation → bone necrosis (e.g. ▫ Periosteal reaction (thickening of
sequestrum); if periosteum bursts → periosteum)
abscess ▫ Aggressive infection → Codman’s
▪ Later: cytokines induce bone resorption triangle (lifted periosteum with triangle-
→ replacement with fibrous tissue → new shaped, ossified edge)
bone formation around necrotic one (e.g.
involucrum)
RISK FACTORS
▪ Diabetes, fractures, splenectomy,
orthopedic procedures/hardware
COMPLICATIONS
▪ If M. tuberculosis disseminates from joint to
vertebra → Pott disease
▪ Inadequate treatment → chronic infection
→ bone fractures, sepsis
Systemic
▪ Weakness, fever, headache, shivering
DIAGNOSIS
DIAGNOSTIC IMAGING
MRI Figure 106.1 An X-ray image of the tibia
▪ Edema → signal changes demonstrating a radiolucency with a sclerotic
border consistent with a Brodie abscess.
588 OSMOSIS.ORG
Chapter 106 Bone & Joint Infections
OTHER DIAGNOSTICS
Needle aspiration guided with ultrasound
▪ Specific antibiotic therapy
TREATMENT
MEDICATIONS
▪ Long-term intravenous antibiotics
SURGERY
▪ Surgical removal of dead bone
▪ Severe cases → amputation
Figure 106.2 A plain radiograph of the right
lower leg of an individual with postoperative
osteomyelitis. The surgical wound started
discharging pus two weeks post open
reduction. There is medial cortical destruction
and loss of trabeculations with lateral cortical
thickening.
SEPTIC ARTHRITIS
osms.it/septic-arthritis
RISK FACTORS
PATHOLOGY & CAUSES ▪ Diabetes
▪ Joint trauma
▪ Joint structures: infected, damaged
▪ Artificial joint, surgical procedure
▪ Pathogen enters the joint via bloodstream,
from nearby infection/directly (e.g. open ▪ Osteomyelitis
fracture) ▪ Chronic arthritis (e.g. rheumatoid arthritis)
▪ Infection of joint → endotoxin production → ▪ Immunocompromised
cytokine release → neutrophil attraction → ▪ HIV
inflammation, damage of joint structures
CAUSES
SIGNS & SYMPTOMS
▪ Most commonly S. aureus (any age group), ▪ Most commonly affects knee; less
Neisseria gonorrhoeae (N. gonorrhoeae; commonly ankle, hip, shoulder
sexual transmission → adults)
OSMOSIS.ORG 589
Local
▪ Restricted range of motion; painful, warm,
swollen joint
Systemic
▪ Fever, weakness
DIAGNOSIS
DIAGNOSTIC IMAGING
X-ray, CT scan
▪ Normal in early stages
▪ ↑ fluid in synovial part of joint
▪ Narrowing of joint space due to destruction
of cartilage
▪ Destruction of bone adjacent to cartilage
Ultrasound TREATMENT
▪ ↑ fluid
▪ Guiding needle for aspiration MEDICATIONS
▪ General antibiotics depending on Gram
LAB RESULTS stain of joint fluid
▪ Switch to specific antibiotics once bacteria
Blood test identified
▪ ↑ white blood cells count (WBC); ↑ ▪ Pain medications (e.g. NSAIDs,
sedimentation rate (ESR) acetaminophen)
Aspiration of joint fluid
▪ → bacterial culture → specific antibiotics SURGERY
▪ Surgically drain, cleanse joint fluid
590 OSMOSIS.ORG