II. Pathophysiology

  1. Infection of infarcted bone
  2. Most common Osteomyelitis sites (due to highly vascular Bone Marrow)
    1. Long bones (multiple sites in same bone may be involved)
    2. Spine
    3. Sternum

III. Causes

  1. Bone infarction
    1. Bone infarction is far more common than Osteomyelitis
  2. Infections
    1. See See Osteomyelitis
    2. Staphylococcal Aureus (<25% of cases)
    3. Salmonella
      1. SCA patients are susceptible to this encapsulated organism due to Asplenia
      2. Most common organism in Sickle Cell AnemiaOsteomyelitis
      3. Other Gram Negative Bacteria may also occur

IV. Signs

  1. Fever
    1. Fever duration directly correlates with likelihood of Osteomyelitis (risk increases 80% each day of fever)
  2. Extremity swelling
    1. Osteomyelitis likelihood increases 8.4 fold
  3. Bone pain
    1. Osteomyelitis likelihood increases 20% each day of pain

V. Diagnosis

  1. Bone Culture

VI. Labs

VII. Imaging

  1. See Osteomyelitis
  2. Interpretation may be difficult in Sickle Cell Anemia as bone infarcts may appear similar to Osteomyelitis

VIII. Management

  1. See Osteomyelitis
  2. Bone infarctions are typically self limited (in contrast, of course, to Osteomyelitis)
  3. Antibiotics are similar to those used in other Osteomyelitis with added Salmonella and Gram Negative coverage
    1. Total Antibiotic course: 6 to 8 weeks
    2. Initial IV: Vancomycin AND (Ciprofloxacin or Ceftriaxone)
    3. Later: May transition to Oral fluoroquinonoles (Ciprofloxacin, Levofloxacin) for susceptible Gram Negative causes

IX. References

  1. Dwyer, Kleinmann, Goswami and Lopez (2025) Crit Dec Emerg Med 39(1): 26-35
  2. Lowe and Wang (2018) Crit Dec Emerg Med 32(11): 17-25
  3. Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23

Images: Related links to external sites (from Bing)

Related Studies