Musculoskeletal Infection and Complications
What you must understand
Know the pathophysiology, diagnosis, and treatment of osteomyelitis (acute and chronic), septic arthritis, and periprosthetic joint infection. Understand biofilm formation and the need for surgical debridement plus culture-directed antibiotics. Be fluent in the complications of fracture and surgery: nonunion, malunion, infection, DVT, fat embolism, and complex regional pain syndrome. Know antibiotic prophylaxis principles and infection control.
Traps in questions
- Chronic osteomyelitis requires surgical debridement of necrotic bone plus antibiotics; biofilm makes antibiotics alone insufficient.
- Septic arthritis is an emergency - joint aspiration, gram stain, culture, and drainage; delay causes cartilage destruction.
- PJI: no single test is definitive; combine serology, synovial analysis, and cultures; two-stage revision for chronic infection.
- DVT prophylaxis after major orthopedic surgery is standard; mechanical and pharmacologic methods.
- CRPS: disproportionate pain, autonomic changes, and functional loss - early recognition and multidisciplinary care.
Worked rule of thumb
For any suspected infection, obtain cultures before antibiotics when feasible, and remember that biofilm demands mechanical disruption - antibiotics alone will fail in chronic infection.
Exam strategy
Questions often test the timing and sequence of intervention - debridement before or with antibiotics, and the role of staged revision.