II. Pathophysiology
- Necrotic bone is identified on presentation (contrast with inflammation in Acute Osteomyelitis)
III. Symptoms and signs
- Presentation may be delayed 6 weeks or more after symptom onset
- Localized bone pain
- Erythema and swelling at affected area
- Draining sinus tracts
- Decreased range of motion of adjacent joints
- Diminished blood supply
IV. Types
- Open Fracture (27% Incidence of Osteomyelitis within 3 months)
- Contigiuous spread from soft tissue infection
- Associated with Diabetic Neuropathy and Peripheral Vascular Disease
- Hematogenous spread from bacteremia
- Much less common in adults than in children
- Vertebrae are most common locations for infection
- See Vertebral Osteomyelitis
- Presents with back pain
- Most common with IV Drug Abuse, Diabetes Mellitus, Chronic Kidney Disease, cancer
- Long bones, Pelvis and clavicle may also be affected
V. Labs
- See Osteomyelitis
VI. Imaging
- See Osteomyelitis
VII. Diagnosis
- Imaging (XRay, bone scan, MRI) demonstrates contiguous soft tissue infection or bony destruction
- Signs suggestive of contiguous Wound Infection spread to bone
- Exposed bone
- Persistent sinus tract
- Tissue necrosis over bone
- Chronic Wound overlying Fracture
- Chronic Wound overlying surgicl hardware
- Labs suggestive of inflammation or infection (sensitive but not specific, more useful in children)
- Blood Cultures positive (Test Sensitivity less than 50%)
- C-Reactive Protein (C-RP) increased
- Erythrocyte Sedimentation Rate (ESR)
- References
- Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
- American Society of Plastic Surgery Guidelines
VIII. Diagnosis: Most Predictive of Osteomyelitis
- Probe-to-Bone Test
-
Skin Ulceration over a bony prominence
- Ulcer present over 2 weeks
- Ulcer over 2 cm in size
- Test Sensitivity: 56%
- Specificity: 92%
- Ulcer depth exceeds 3 mm
IX. Management
X. References
- Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
- Boutin (1998) Orthop Clin North Am 29:41-66 [PubMed]
- Carek (2001) Am Fam Physician 63(12):2413-20 [PubMed]
- Dirschl (1993) Drugs 45:29-43 [PubMed]
- Eckman (1995) JAMA 273:712-20 [PubMed]
- Haas (1996) Am J Med 101:550-61 [PubMed]
- Lew (1997) N Engl J Med 336:999-1007 [PubMed]
- Lipsky (1997) Clin Infect Dis 25:1318-26 [PubMed]
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| Concepts | Disease or Syndrome (T047) |
| ICD10 | M86.2 , M86.20, M86.29 |
| SnomedCT | 203301008, 67322009 |
| German | Subakute Osteomyelitis |
| Korean | 아급성 골수염 |
| English | Subacute osteomyelitis, unspecified site, Subacute osteomyelitis, site unspecified, osteomyelitis subacute, osteomyelitis subacute (diagnosis), Subacute osteomyelitis with or without periostitis, Subacute osteomyelitis, Subacute osteomyelitis (disorder), osteomyelitis; subacute, subacute; osteomyelitis |
| Dutch | osteomyelitis; subacuut, subacuut; osteomyelitis, Subacute osteomyelitis |
| Spanish | osteomielitis subaguda (trastorno), osteomielitis subaguda con o sin periostitis, osteomielitis subaguda |
