Surgical Infections II – A. Osteomyelitis, Acute and Chronic
Questions

  1. Which of the following statements concerning osteomyelitis and septic arthritis is false ?
    1. Osteomyelitis involving the proximal femur neck always involves the hip joint.
    2. Osteomyelitis and septic arthritis seldom co-exist.
    3. Prior to 2 years of age osteomyelitis frequently spreads to the joint space.
    4. Joint fluid with a cell count of over 80,000 is consistent with septic arthritis.

 

  1. Which statement is correct ?
    1. The rigid bone tissue is resistant to infection.
    2. The periosteum is the source of new bone formation after injury.
    3. The development of periosteal new bone formation excludes the possibility of chronic osteomyelitis.
    4. In children under 2 the epiphyseal plate is a barrier to the spread of infection.

 

  1. Which of the following statements concerning chronic osteomyelitis is false ?
    1. The involucrum protects the underlying bone from further infection.
    2. Removal of all necrotic bone is necessary to eradicate infection.
    3. Removal of sequestra prior to adequate formation of involucra may result in bony instability.
    4. Most cases of chronic osteomyelitis are a result of late or inadequate treatment of acute Osteomyelitis.

 

  1. A 3 year old boy presents with fever, a swollen right lower leg and inability to bear weight for 3 days. He comes from a poor rural community and vaccinations have not been completed. Examination reveals an ill looking child with tenderness over the upper tibia. Which of the following would be the most appropriate initial management?
    1. Technium bone scan and if positive starting patient on intravenous penicillin.
    2. Xray limb and if negative for osteomyelitis reassuring the family that the boy does not have this condition.
    3. Xray limb as baseline, aspiration of upper tibia and knee joint. If no pus is found proceeding to drill upper tibia. On finding pus drainage of the affected tissue and starting ceftriaxone.
    4. Aspirating limb and if pus is found starting ceftriaxone.

 

  1. A 40 year old man presents in the emergency department with an open contaminated fracture of the mid tibia and fibula. Which would be the most appropriate treatment?
    1. Immediate internal fixation of the tibia and closure of the wound to prevent infection.
    2. Debridement of the wound and underlying soft tissue, delayed primary closure, short term peri-operative antibiotics and stabilization of the fracture with temporary calcaneal traction.
    3. Immediate closure of the wound and external fixation of the bone.
    4. Peri-operative antibiotics, debridement and closure of the wound and immediate application of circular plaster to stabilize the fracture.

 

  1. A 10 year old girl presents with pain in the right lower leg, a draining sinus, and deformity of the limb. Xray of the limb shows chronic osteomyelitis with a large sequestrum. Which would not be correct management?
    1. Discussion with the family of the nature of the disease and the difficulty in eradication.
    2. Delay of removal of sequestrum until adequate involucrum formed.
    3. Operative strategy of sequestrum removal includes post-operative soft tissue coverage.
    4. Antibiotic therapy should be based on culture of the sinus tract.

    Answers to these questions will be provided next month!

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