< Back Legg-Calvé-Perthes Disease legg-calve-perthes-disease Previous Next

< Back Posterolateral Corner Injury Previous Next

< Back Infected Nonunion infected-nonunion Previous Next

< Back Imaging Q shoulder-elbow-imaging Previous Next

< Back Alper DUNKI Musculoskeletal Infections and Microbiology Spot Knowledge Staphylococcus aureus is the leading cause of MSK infections. MRSA strains (community vs hospital) differ in virulence. Children 6 mo–4 yrs: Kingella kingae is most common. Sickle cell disease: Salmonella is typical pathogen. Implant infections: Biofilm formation → requires debridement. MRI is nearly 100% sensitive in early osteomyelitis. Epidemiology & Microbiology Main pathogens: S. aureus , S. epidermidis, coagulase-negative staphylococci. Gram-negative: E. coli, Proteus, Klebsiella, Enterobacter . IV drug users: Pseudomonas, Serratia, fungi . Gonococcal arthritis: Neisseria gonorrhoeae in young adults. Post-shoulder surgery: Propionibacterium acnes . Pathogenesis Synovium lacks basement membrane → easy microbial entry. S. aureus virulence factors: Protein A, polysaccharide capsule, biofilm, PVL toxin. Biofilms protect bacteria in prosthetic joint infection → need surgery + antibiotics . Clinical Findings Septic arthritis: monoarticular, knee most common. Kocher criteria (peds): fever, non-weight bearing, ESR >40, WBC >12,000. Osteomyelitis (peds, MRSA risk): fever >38°C, Hct <34%, WBC >12,000, CRP >13. Diagnosis Radiology: joint space narrowing, periosteal reaction, Codman’s triangle. MRI: gold standard, early detection. Lab: CRP, ESR monitoring. Synovial fluid: WBC >50,000, >90% PMN highly suggestive. Treatment Osteomyelitis: 4–6 wks (≥6 for MRSA). Septic arthritis: 3–4 wks. Adults empiric: Vancomycin + Ceftriaxone. Children (MRSA): IV Vancomycin (15 mg/kg q6h). Implant infection: add Rifampin (synergy vs biofilm). C. difficile must be considered in prolonged antibiotic use . Antibiotic Prophylaxis in Orthopaedics Not routine in elective surgery without implants. Give ≤1 h before incision (Vanco: 2 h prior). 1st line: cephalosporins. Clinda/Vanco for β-lactam allergy. Duration: ≤24 h. Prevention of Surgical Site Infection Risk factors: DM, obesity, malnutrition, smoking, RA, MRSA colonization. Measures: chlorhexidine prep, double gloving, monofilament sutures, drains <24h, normothermia, glycemic control. Periprosthetic Joint Infection Knee arthroplasty: Synovial WBC >2,500/mm³ or >90% PMN → chronic infection. Gram stain not useful. Atypical & Rare Infections Necrotizing fasciitis: S. pyogenes, CA-MRSA; urgent surgery. Gas gangrene: Clostridium spp., surgery + high-dose PCN/Clinda. TB: spine most common, 4-drug ≥6 months. NTM: M. marinum (hand infections post-water exposure). Vibrio vulnificus: severe necrotic infection after seawater. Candida albicans: rare prosthetic infection. Lyme (Borrelia): late monoarthritis. HIV/AIDS: optimize immunity pre-surgery . References Masters EA, et al. Nat Rev Microbiol . 2022. Touaitia R, et al. Antibiotics . 2025. Sanpera I, et al. Current Concepts in Septic Arthritis . 2024 . Previous Next

< Back Open Fracture Management Open fractures require urgent assessment, debridement, and staged fixation to minimise infection and optimise outcomes. Galeazzi fracture is a distal radial shaft fracture with dislocation of the distal radioulnar joint (DRUJ). Internal fixation of the radius and assessment of DRUJ stability are essential. open-fracture Previous Next

< Back Foot & Toes C A foot-toes Previous Next

< Back Occipital-Cervical Injuries fenerbahçe Previous Next

< Back Dr. Osman Emre AYCAN Istanbul Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Orthopaedics and Traumatology Education and Training 2009 – 2015 – Istanbul Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital , Residency in Orthopaedics and Traumatology Thesis Advisor: Dr. Sami Sökücü 2001 – 2007 – Istanbul University, Cerrahpaşa Faculty of Medicine (English Program) Professional Experience 2020 – Present – Istanbul Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital , Orthopaedic Surgeon 2015 – 2020 – Istanbul Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital , Orthopaedic Specialist 2009 – 2015 – Istanbul Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital , Resident Physician in Orthopaedics and Traumatology Oncologic Orthopaedics Previous Next

< Back Dr. Sefa Giray BATIBAY University of Health Sciences, Istanbul, Umraniye Research and Education Hospital Oncologic Orthopaedics sefabatibay@hotmail.com Previous Next

< Back Charcot Arthropathy charcot-arthropathy Previous Next