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Osteomyelitis XRay

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1. Xray features Chronic Osteomyelitis :DAMS eQ Series

Xray features Chronic Osteomyelitis :DAMS eQ Series Xray features Chronic Osteomyelitis :DAMS eQ Series - Sumer's Radiology Blog Top Ad unit 728 × 90 Radiology News radiology Xray features Chronic Osteomyelitis :DAMS eQ Series Xray features Chronic Osteomyelitis :DAMS eQ Series Sumer Sethi About Dr. Sumer Sethi Number of Entries : 35 Unique blend of academic excellence and entrepreneurship, heading leading firms in India- Teleradiology Providers, pioneering company providing teleradiology

2018 Sumer's Radiology Blog

2. Osteomyelitis XRay

Osteomyelitis XRay Osteomyelitis XRay Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Osteomyelitis XRay Osteomyelitis XRay Aka (...) : Osteomyelitis XRay , Osteomyelitis Plain Radiography , XRay in Suspected Osteomyelitis II. Indications First line study in evaluation due to low cost and high availability Narrows differential diagnosis by ruling out other causes Metastases to bone Osteoporotic s III. Findings: Early Soft tissue swelling Periosteal reaction (Subperiosteal elevation) IV. Findings: Later Osteolysis Sequestra (islands of necrotic bone) Bone abscess (Brodie's abscess) V. Efficacy : 62% (43-75% in ) : 64% (65-83% in ) VI

2018 FP Notebook

3. Osteomyelitis XRay

Osteomyelitis XRay Osteomyelitis XRay Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Osteomyelitis XRay Osteomyelitis XRay Aka (...) : Osteomyelitis XRay , Osteomyelitis Plain Radiography , XRay in Suspected Osteomyelitis II. Indications First line study in evaluation due to low cost and high availability Narrows differential diagnosis by ruling out other causes Metastases to bone Osteoporotic s III. Findings: Early Soft tissue swelling Periosteal reaction (Subperiosteal elevation) IV. Findings: Later Osteolysis Sequestra (islands of necrotic bone) Bone abscess (Brodie's abscess) V. Efficacy : 62% (43-75% in ) : 64% (65-83% in ) VI

2015 FP Notebook

4. Diabetic Foot Osteomyelitis

Diabetic Foot Osteomyelitis Diabetic Foot Osteomyelitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Diabetic Foot Osteomyelitis (...) Diabetic Foot Osteomyelitis Aka: Diabetic Foot Osteomyelitis , Osteomyelitis Management in Diabetes Mellitus , Suspected Osteomyelitis in Diabetes Mellitus , Diabetes Mellitus Associated Osteomyelitis From Related Chapters II. Differential Diagnosis III. Findings: Red Flags suggestive of Foot Osteomyelitis Sausage toe (swollen, deformed red toe) Bone Visualized or positive with red flags Infected ulcer with ESR >70 mm/h or unexplained Non-healing ulcer despite several weeks of wound care and non-weight

2018 FP Notebook

5. Chronic Osteomyelitis

Chronic Osteomyelitis Chronic Osteomyelitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Chronic Osteomyelitis Chronic (...) Osteomyelitis Aka: Chronic Osteomyelitis , Subacute Osteomyelitis , Osteomyelitis in Adults From Related Chapters II. Pathophysiology Necrotic bone is identified on presentation (contrast with inflammation in ) III. Symptoms and signs Presentation may be delayed 6 weeks or more after symptom onset Localized bone pain Erythema and swelling at affected area Draining sinus tracts Decreased range of motion of adjacent joints Diminished blood supply IV. Types Open (27% of within 3 months) Contigiuous spread from

2018 FP Notebook

6. Acute Osteomyelitis

Acute Osteomyelitis Acute Osteomyelitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Acute Osteomyelitis Acute Osteomyelitis Aka (...) : Acute Osteomyelitis , Osteomyelitis in Children , Pediatric Osteomyelitis From Related Chapters II. Epidemiology More common in boys III. Pathophysiology Inflammatory bone changes associated with pathogenic is most common cause in Pediatric Osteomyelitis Typically acute hematogenous spread to tized bone Most common in children under age 5 (50% of cases) Most commonly affects the highly vascular metaphyses of long bone IV. Symptoms Presentation within two weeks of symptom onset Irritability

2018 FP Notebook

7. Sclerosing Osteomyelitis of Garre

Sclerosing Osteomyelitis of Garre Sclerosing Osteomyelitis of Garre - Sumer's Radiology Blog Top Ad unit 728 × 90 Radiology News radiology Sclerosing Osteomyelitis of Garre Sclerosing Osteomyelitis of Garre * Excess periosteal reaction by an extremely sensitive periosteum in response to a low grade anaerobe. * Manifests as long standing chronic Osteomyelitis without any abscess or sequesterum formation. * XRay - Expanded bone with generalised sclerosis * ESR - Usually elevated * Culture (...) - Usually Negative * Antibiotics and fenesteration of the sclerotic bone is usually helpful Case Submitted by Dr Tushar Mehta MBBS , DNB , MS (USAIM) , MNAMS Orthopaedic Surgeon Sclerosing Osteomyelitis of Garre Reviewed by Sumer Sethi on Sunday, July 31, 2016 Rating: 5 Tags : Sumer Sethi About Dr. Sumer Sethi Number of Entries : 35 Unique blend of academic excellence and entrepreneurship, heading leading firms in India- Teleradiology Providers, pioneering company providing teleradiology services

2016 Sumer's Radiology Blog

8. Acute Osteomyelitis

Acute Osteomyelitis Acute Osteomyelitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Acute Osteomyelitis Acute Osteomyelitis Aka (...) : Acute Osteomyelitis , Osteomyelitis in Children , Pediatric Osteomyelitis From Related Chapters II. Epidemiology More common in boys III. Pathophysiology Inflammatory bone changes associated with pathogenic is most common cause in Pediatric Osteomyelitis Typically acute hematogenous spread to tized bone Most common in children under age 5 (50% of cases) Most commonly affects the highly vascular metaphyses of long bone IV. Symptoms Presentation within two weeks of symptom onset Irritability

2015 FP Notebook

9. Chronic Osteomyelitis

Chronic Osteomyelitis Chronic Osteomyelitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Chronic Osteomyelitis Chronic (...) Osteomyelitis Aka: Chronic Osteomyelitis , Subacute Osteomyelitis , Osteomyelitis in Adults From Related Chapters II. Pathophysiology Necrotic bone is identified on presentation (contrast with inflammation in ) III. Symptoms and signs Presentation may be delayed 6 weeks or more after symptom onset Localized bone pain Erythema and swelling at affected area Draining sinus tracts Decreased range of motion of adjacent joints Diminished blood supply IV. Types Open (27% of within 3 months) Contigiuous spread from

2015 FP Notebook

10. Diabetic Foot Osteomyelitis

Diabetic Foot Osteomyelitis Diabetic Foot Osteomyelitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Diabetic Foot Osteomyelitis (...) Diabetic Foot Osteomyelitis Aka: Diabetic Foot Osteomyelitis , Osteomyelitis Management in Diabetes Mellitus , Suspected Osteomyelitis in Diabetes Mellitus , Diabetes Mellitus Associated Osteomyelitis From Related Chapters II. Differential Diagnosis III. Findings: Red Flags suggestive of Foot Osteomyelitis Sausage toe (swollen, deformed red toe) Bone Visualized or positive with red flags Infected ulcer with ESR >70 mm/h or unexplained Non-healing ulcer despite several weeks of wound care and non-weight

2015 FP Notebook

11. Appropriate Use Criteria: Positron Emission Testing, Other PET Applications, including Oncologic Tumor Imaging

-glucose (FDG) are still under active investigation. Technology Considerations The use of PET is generally limited to clinical situations in which tissue confirmation of malignancy has been established and standard imaging has not provided sufficient information to guide treatment decisions. Standard imaging usually consists of CT or MRI, but may include xray, bone scan or ultrasound. In the majority of situations where residual or recurrent disease is of concern, biopsy remains the most reliable (...) is currently only a covered benefit by the Centers for Medicare & Medicaid Services with CED. PET bone scanning is an evolving technology under clinical development. This technology and its impact on health outcomes will continue to undergo review as new evidence-based studies are published. PET bone scan is considered not medically necessary. PET Imaging of Infectious Processes For diagnosis of chronic osteomyelitis involving the axial skeleton References 1. Alpert JB, Lowry CM, Ko JP. Imaging

2018 AIM Specialty Health

12. Use of Imaging Prior to Referral to a Musculoskeletal Oncologist

radiograph VS. Cytology(fine needle aspiration biopsy) radiologist interpretation 0.7727|0.967 23.96|0.24 STRONG WEAK Moderate Quality Weger,C., 2013 85 66% pain pts osteolytic lesions of os calcis Radiograph(plain) VS. Histopathology(biopsy ) radiologist interpretation 0.3|1 30.00|0.70 STRONG POOR Low Quality Strobel,K., 2008 50 bone tumors xray VS. histology(US or CT-guided biopsy or resection) or CFU(4pts; 12mo) radiologist interpretation(i ll-defined lesion, cortical destruction, periosteal reactions

2018 American Academy of Orthopaedic Surgeons

13. CRACKCast E176 – Pediatric Musculoskeletal Disorders

and strengthening of the rotator cuff. Think of the 1-2-3 rule for clavicle fractures. Three parts to it Parts 1 and 3 are “odd” – because they are rare and should probably be run by the ortho on call if there is any displacement Part 2 (middle ⅓) is “even” more common and up to 2 cm of displacement is allowed. [2] List 5 Xray features of supracondylar fracture Until age 8 the ligaments and joint capsule around the elbow are stronger than the bone, so make sure you see three proper views: AP view (...) or pelvis fractures, overuse injuries Infection : septic arthritis, osteomyelitis, myositis, Lyme disease Inflammation : transient synovitis, juvenile rheumatoid arthritis, rheumatic fever Neoplasm : leukaemia, osteogenic/Ewing’s sarcoma, metastatic disease Haematologic disorders : haemophilia, sickle cell disease Miscellaneous : Legg-Calvé-Parthes disease, slipped capital femoral epiphysis [11] Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent. Toddler School

2018 CandiEM

14. CRACKCast E057 – Knee and Lower Leg

classification I: hinged up with no displacement from the proximal base II: tubercle avulsed III: extend into the articular surface Xray Type 1: cast immobilization with knee in extension Type 2-3 usually need reduction, possible ORIF and immobilization Osgood-Schlatter Disease “Osteochondritis of the tibial tuberosity” Traction apophysitis Usually occurs in athletic adolescents Painful swelling over the tibial tubercle – relieved by rest May be bilateral Pain with resisted knee extension Clinical dx, an x (...) union times is 20-30 weeks Malrotation CRPS (tenuous blood supply) = increased risk of osteomyelitis & non-union 12) Describe the management of proximal fibula fractures The fibula is a non-weight bearing bone that helps keep the tibial weight bearing surface in place on the plafond Isolated fibula #s usually occur from a direct blow But rare cases: Maisonneuve fracture Must assess peroneal nerve function (foot drop) and LCL status Important to get knee and ankle joint x-rays Management: Symptom

2017 CandiEM

15. CRACKCast E058 – Ankle and Foot

scan: stress fractures and ligament injuries MRI: ligament and tendon anatomy and subtle bone marrow changes seen in stress fractures before seen on x ray CT-SPECT imaging: impingement syndromes, tumors, osteomyelitis Look at least 11 spots including “tear drop” sign of joint effusion and ensure NO more than 4 mm in the medial clear space: Ottawa ankle and foot rules, 100% sensitive See: Weight bearing defined as the ability to transfer weight onto each leg regardless of limping at least 4 steps (...) pain syndrome Occurs months after trauma Diffuse burning, aching, searing Vasomotor instability Persistent foreign body Stress fractures Break it down into Hindfoot pain Stress fractures of talus or calcaneus Impingement by os trigonum: pain during plantar flexion of the foot in ballet dancers Subcalcaneal foot pain: Plantar fasciitis: Overuse injury Pain during gait Calcaneal spur on plain xray Treatment: Rest, padding, orthotics, NSAIDs Subcalcaneal bursitis Rupture of plantar fascia Nerve

2017 CandiEM

16. CrackCAST E136 – Bone and Joint Infections

of bloodwork? One liner: If the history and exam looks like osteomyelitis, only really need a ESR w/ XRAY and probe-to-bone test. In general labs are not useful in completely well looking patients. Gold standard is bone biopsy & culture!!! See the Rosen’s algorithm Figure 128.2 in 9 th Edition Lab notes: With acute osteomyelitis, WBC can be up, but neither sensitive nor specific Chronic osteomyelitis can have normal WBC The ESR (or CRP) = more helpful than the WBC count. Can help RULE IN, but cannot RULE (...) CrackCAST E136 – Bone and Joint Infections CrackCAST E136 - Bone and Joint Infections - CanadiEM CrackCAST E136 – Bone and Joint Infections In by Chris Lipp December 18, 2017 This episode of CRACKCast covers Rosen’s Chapter 128, Bone and Join Infections. This episode will look specifically at osteomyelitis and septic arthritis, infections can be subtle and difficult to diagnose, but with devastating consequences if missed. Shownotes – Key Concepts Skeletal infection should be considered

2017 CandiEM

17. UNiD 3D VBR Register

] EMS: European Myelopathy Score Pain [ Time Frame: preoperatively and 6,12, and 24 months postoperation ] Visual Analog Score Disability [ Time Frame: preoperatively and 6,12, and 24 months postoperation ] Neck disability index Variation of radiological vertebral heights [ Time Frame: 6,12, 24 months ] Xrays assessment of segmental height operated Variation of radiological vertebral angulation [ Time Frame: 6,12, 24 months postoperativley ] Xrays assessment of C2C7 angle and corpectomy angles (...) : Osteomyelitis) Spinal instability Symptomatic degenerative spinal disease Inflammatory rheumatism. Pseudarthrosis Thoracolumbar region Fracture / Trauma Tumors Infection (Ex: Osteomyelitis) Spinal instability Symptomatic degenerative spinal disease Pseudarthrosis Patients > 18 years Patients who signed an Informed Consent Form Exclusion Criteria: Patients who can't or doesn't want to sign an ICF Patients unable to fill HRQOL questionnaires Non-compliant paitents regarding follow-up or protocol Pregnant

2016 Clinical Trials

18. Skeletal Tuberculosis

Tuberculosis (most common involvement) of weight bearing joints Presents with insidious monoarticular pain, swelling May form superficial abscesses and drain to skin Poncet's Disease (rare) Acute sterile Associated with visceral involvement Tuberculous Osteomyelitis May involve any bone V. Signs Doughy synovitis on joint palpation VI. Labs ( ) Positive in most cases Exam See VII. Radiology: Chest XRay Pulmonary involvement in only 50% of Tb VIII. Diagnosis Arthrocentesis with culture : 80% Synovial biopsy (...) Tuberculosis Aka: Skeletal Tuberculosis , Tuberculous Arthritis , Pott's Disease , Poncet's Disease , Spinal Tuberculosis , Articular Tuberculosis , Tuberculous Osteomyelitis , Gibbus II. Definition secondary to III. Epidemiology Represents 35% of IV. Distribution Spinal Tuberculosis (Pott's Disease) most commonly involved Associated with paraspinous abscess Destroys anterior l body and adjacent disc Results in anterior wedging Forms prominence of spine known as Gibbus May compress central cord Articular

2018 FP Notebook

19. Skin Infections in Diabetes Mellitus

/hour correlates with Diabetic Foot Infection culture Avoid superficial culture swabs due to inaccuracy from contamination Currettage from debrided ulcer base or obtain deep specimen tissue biopsy VIII. Imaging: Suspected Osteomyelitis See XRay extremity See Baseline study observing for local bone destruction, gas formation or foreign body Poor (as low as 25%), especially in early diabetic ulcers or mild infections (under a few weeks in duration) Bone Scan See Triple Phase Bone Scan for 90 (...) Significant wound necrosis Gangrene Limb-critical ischemia Urgent or emergent intervention required Surgery Indications Deep abscess Bone or joint extensively involved Crepitation Significant wound necrosis Gangrene XII. Complications: Diabetic Foot Osteomyelitis See Epidemiology Present in 20% of mild to moderate Diabetic Foot Infections Present in up to 60% of severe Diabetic Foot Infections Indications to evaluate for s >2 cm in diameter s >3mm deep s overlying a bony prominence Chronic s refractory

2018 FP Notebook

20. Bites - human and animal

if there is a break in the skin. Infective complications resulting from a bite wound include abscesses, tenosynovitis, septic arthritis, osteomyelitis, and systemic spread (for example sepsis, meningitis, endocarditis, and organ abscesses). Tetanus can occur after an animal bite or human bite, especially in puncture wounds or those containing devitalized tissue, dirt, or foreign bodies. However, tetanus after a human bite is extremely rare. Rabies is very rare in the UK as there is no indigenous rabies (...) bull terriers able to cause significant damage [ ; ]. Cats have fine, sharp teeth and, despite having a weaker bite than dogs, inflict deep puncture wounds inoculated with saliva, and are capable of penetrating bone, joints, and tendons [ ; ; ; ]. Fluids can only drain from the small skin puncture wounds, therefore infections such as abscesses and osteomyelitis are more common with cat bites [ ]. Prevalence How common are bites? The true incidence of bites is probably underestimated because some

2013 NICE Clinical Knowledge Summaries

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