OSTEOMYLITIS | a bone infection caused by bacteria or

other germs. TYPES

1. Acute a. Infx develop in 2wks of initial infx/ injury/nderlying dsz response to antibiotics b. 2 ways (1) hematogenous & (2) contiguous 2. Chronic a. Infx produce irreversible bony changes cannot be treated with antibiotics b. Complication of pre existing infx/ dsz (1) HEMATOGENOUS Disease of children/ adult? Cx agent: Staph Aureus, Strep pyogenes (GABH), GBS, Haemophilus influenza (2) CONTIGUOUS/ DIRECT Direct contact of infected tissue with bone as may occur during a surgical procedure or following trauma. Adults? Associated history of accidental or surgical trauma

RISK FX
Weakened immune system Poor circulation Diabetes and foot injury Injury and trauma Orthopaedic surgery Intravenous drug use

SYMPTOMS
Acute osteomyelitis: Sudden high fever of 38C / > Severe bone pain Swelling, redness and warmth @ infx site Affected site is tender to touch ROM is restricted Swollen lymph nodes nearby Chronic osteomylitis: Bone pain Feeling persistently tired Pus draining from the sinus tract Local swelling, redness Skin changes Excessive sweating & chills

DIAGNOSING
1. Blood a. b. c. d. test FBC Hb, TWC C & S - identify organisms CRP & ESR Antistaphylococal antibody 2. Imaging a. Plain radiograph i. Periosteal thickening or elevation ii. Cortical thickening, sclerosis, and

TREATMENT
Acute Early (<48hrs) Rest & splintage IV antibiotics (ampicillin + cloxacillin ) 4 to 6 wks Late (>48hrs) Incision & drainage IV antibiotics Chronic Require a combination of antibiotics & surgery to remove any damaged

irregularity iii. Loss of trabecular architecture, osteolysis, and new bone formation b. MRI & CT c. Ultrasonography d. Radioisotope scintigraphy

bone Aims for surgery - removal of sequestrum, granulation tissue & sinus - elimination of dead space

COMPLICATION
Acute 1. Septicaemia, pyaemia 2. Septic arthritis 3. Chronic osteomyelitis 4. Pathological # 5. Growth disturbance Chronic 1. Pathological # 2. Growth disturbance 3. Joint stiffness 4. Malignancy

DEEP VEIN THROMBOSIS (DVT) | blood clot that

forms in a vein deep in the body WHAT
Commonly involves the deep veins of the leg or arm 40 year old M>F

CAUSES
Virchow triad; (1) venous stasis (2) activation of blood coagulation (3) vein damage SIGN & SYMPTOMS Limb pain & edema Tenderness at the calf muscle Warmth & erythema Red or discolored skin on the leg Unexplained shortness of breath Pain with deep breathing Coughing up blood Calf pain on dorsiflexion of the foot (Homans sign)

RISK FX
Age Immobilization > 3 days Pregnancy and the postpartum period Major surgery in previous 4 weeks Long plane or car trips (>4 hrs) in previous 4 weeks Previous DVT Stroke Factor V Leiden Overweight/ obesity

DIAGNOSING
Coagulation profile Ultrasound D dimer/ venography

TREATMENT
OBJECTIVE: to prevent pulmonary embolism (PE) 1. Anticoagulant 2. Thrombolytics 3. Thrombin inhibitors