0071643192.pdf

ORTHOPEDICS

■ Direct or contiguous spread from nearby soft tissue infection

■ S. aureus,Enterobacterspecies, and Pseudomonas

■ Puncture through sole of shoe: S. aureus is most common;Pseudomonas

is the most characteristic

■ Sickle cell disease: S. aureus is most common;Salmonellais the most

characteristic

■ Often trauma related

■ Vertebral osteomyelitis is more common in patients >45 years old.

SYMPTOMS/EXAM

■ Can be relatively nonspecific

■ Fever

■ Fatigue

■ Local swelling, erythema, and tenderness

DIAGNOSIS

■ Clinical suspicion; two of four criteria required:

■ Purulent material on aspiration of affected bone

■ Positive culture of bone tissue or blood

■ Localized bony tenderness with overlying soft-tissue erythema or edema

■ Positive radiological imaging study

■ X-ray may reveal periosteal elevation or soft-tissue edema. Later, bony lucen-

cies may be apparent. Most often, no X-ray abnormalities early in the course

of disease.

TABLE 4.4. Indications for Emergent Ankle or Foot Orthopedic Intervention and Injuries

for Orthopedic Referral

ORTHOPEDICEMERGENCIES ORTHOPEDISTREFERRAL(< 72 HOURS)

Major talar neck and body fractures Extra-articular calcaneal fractures

Intra-articular calcaneus fractures First metatarsal fracture

All open fractures Displaced metatarsal shaft

All fracture dislocations Unstable ligamentous injuries

Maisonneuve fractures with Stable unimalleolar fracture

neurovascular compromise

Bimalleolar and trimalleolar fractures Peroneal dislocations

with neurovascular compromise

Lisfranc injuries Maisonneuve, bimalleolar, and

trimalleolar fractures with good

reduction, no neurovascular

compromise, and ensured orthopedic

follow-up

Compartment syndromes Jones fracture