Essentials of Orthopedic Surgery, third edition / 03-Orthopedic Infections

104 S.C. Scherping, Jr. and A.D. Aaron

the proper host with early and effective therapy, the long-term sequelae of an infection will most typically be modest to unrecognizable. It is for this reason that all clinicians should be able to recognize and initiate management, even if only to make appropriate referral, for all patients suspected of having an orthopaedic infection.

Suggested Readings

Cierny G. Chronic osteomyelitis: results of treatment. Instructional Course Lectures 1990;39:495–508.

Esterhai JL Jr (ed) Orthopaedic infections. Orthop Clin North Am 1991;22:3. Evarts CM (ed) Surgery of the Musculoskeletal System, 2nd ed. New York:

Churchill Livingstone, 1990.

Green NE, Edwards K. Bone and joint infections in children. Orthop Clin North Am 1987;18:555–576.

Gristina AG. Biomaterial-centered infection: microbial adhesion vs. tissue integration. Science 1987;237:1588–1595.

Questions

Note: Answers are provided at the end of the book before the index.

3-1. The involucrum is best described as:

a.Necrotic bone within a bed of osteomyelitis

b.Rim of soft tissue enhancement surrounding an infection

c.Reactive new bone formation around a sequestrum

d.Thickened joint capsule following a septic arthritis

3-2. Which of the following organism is the most common pathogen in pediatric age group osteomyelitis?

a.Streptococcus pneumoniae

b.Streptococcus veridans

c.Group-B streptococci

d.Staphylococcus aureus

3-3. Plain radiographs begin to demonstrate changes within the bone consistent with osteomyelitis after?

a.2 days

b.10 days to 2 weeks

c.4 weeks

d.3 months

3-4. Which of the following organism(s) is the most common pathogen found in an adult with a septic arthritis?

a.Gram-negative rods

b.Staphylococcus aureus

c.Mycobacterium

d.Streptococcus pyogenes

3-5. Bacterial growth in a biofilm or “slime layer” around an implant may be resistant to antibiotic therapy because of:

a.Alterations in the local pH

b.van der Waals forces between the bacteria

c.Phenotypic changes in surface-adherent bacteria altering their antibiotic susceptibility

d.Insufficient vascular supply

3-6. The most common etiology for acute osteomyelitis in children is?

a.Hematogenous inoculation

b.Poor immune defense mechanisms

c.Direct inoculation

d.Poor hygiene

3-7. Which of the following factor(s) predispose an adult to the development of a septic arthritis?

a.Systemic steroid use

b.Preexistent arthritis

c.Intraarticular injection/aspiration

d.All of the above

3-8. What is the earliest identifiable change consistent with osteomyelitis that may be evident on plain radiographs?

a.Bone destruction

b.Soft tissue swelling

c.Joint effusion

d.Bony sclerosis

3-9. The initial treatment of a patient presenting to the emergency room with an open fracture includes all the following except?

a.Gentle wound inspection

b.Administration of intravenous antibiotics

c.Provisional fracture stabilization with splint or traction

d.Deep wound probing with the purpose of obtaining cultures

3-10. Appropriate antibiotic therapy for a patient presenting to the emergency room with a puncture wound (measuring less than 5 mm) through the forearm and an associated both bone forearm fracture includes?

a.No antibiotics are appropriate in this setting

b.An aminoglycoside along with penicillin

c.First-generation cephalosporin

d.First-generation cephalosporin with an aminoglycoside