II. Pathophysiology
- Infection of infarcted bone
- Most common Osteomyelitis sites (due to highly vascular Bone Marrow)
- Long bones (multiple sites in same bone may be involved)
- Spine
- Sternum
III. Causes
- Bone infarction
- Bone infarction is far more common than Osteomyelitis
- Infections
- See See Osteomyelitis
- Staphylococcal Aureus (<25% of cases)
- Salmonella
- SCA patients are susceptible to this encapsulated organism due to Asplenia
- Most common organism in Sickle Cell AnemiaOsteomyelitis
- Other Gram Negative Bacteria may also occur
IV. Signs
-
Fever
- Fever duration directly correlates with likelihood of Osteomyelitis (risk increases 80% each day of fever)
- Extremity swelling
- Osteomyelitis likelihood increases 8.4 fold
- Bone pain
- Osteomyelitis likelihood increases 20% each day of pain
V. Diagnosis
- Bone Culture
VI. Labs
-
Blood Cultures
- Test Sensitivity: 30 to 76%
VII. Imaging
- See Osteomyelitis
- Interpretation may be difficult in Sickle Cell Anemia as bone infarcts may appear similar to Osteomyelitis
VIII. Management
- See Osteomyelitis
- Bone infarctions are typically self limited (in contrast, of course, to Osteomyelitis)
-
Antibiotics are similar to those used in other Osteomyelitis with added Salmonella and Gram Negative coverage
- Total Antibiotic course: 6 to 8 weeks
- Initial IV: Vancomycin AND (Ciprofloxacin or Ceftriaxone)
- Later: May transition to Oral fluoroquinonoles (Ciprofloxacin, Levofloxacin) for susceptible Gram Negative causes
IX. References
- Dwyer, Kleinmann, Goswami and Lopez (2025) Crit Dec Emerg Med 39(1): 26-35
- Lowe and Wang (2018) Crit Dec Emerg Med 32(11): 17-25
- Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23