Osteomyelitis

Aka: Osteomyelitis

II. Classification: Waldvogel System

  1. Acute Osteomyelitis: Hematogenous Seeding
    1. Child with long bone metaphysis infection
  2. Chronic Osteomyelitis: Wound associated
    1. Adult with open injury to bone and soft tissue
  3. Contiguous spread of infection
    1. No generalized vascular disease
    2. Generalized vascular disease

III. Causes

  1. See Osteomyelitis Causes

IV. Types

  1. Acute Osteomyelitis
    1. Typical case is a 1-2 week history of fever, Joint Pain in the long bone of a child (hematogenous spread)
  2. Chronic Osteomyelitis
    1. Typical case is a 4-6 week history of malaise, regional pain at an open wound in an adult (contiguous spread)

V. Labs

  1. Inflammation markers
    1. General
      1. More useful in children, especially in ruling out Osteomyelitis (serial negative markers)
      2. Sensitive, but not specific
    2. Complete Blood Count (CBC)
      1. Leukocytosis
    3. Erythrocyte Sedimentation Rate (ESR) exceeds 70
      1. Test Sensitivity: 28%
    4. C-Reactive Protein (CRP)
  2. Bone Biopsy (Gold Standard)
    1. Test Sensitivity: 95%
    2. Specificity: 99%
    3. Polymicrobial infections are more common in Chronic Osteomyelitis
    4. Consider specific testing in atypical cases (e.g. Mycobacterium tuberculosis)
  3. Blood Culture
    1. Test Sensitivity: <50%
    2. Positive Blood Culture with clinical findings suggestive of Osteomyelitis may obviate the need for bone culture
  4. Superficial wound culture
    1. Not recommended due to contamination

VI. Imaging

  1. Osteomyelitis XRay
    1. Typical appearance is the "rat bite" of destroyed bony cortex
    2. First line study due to low cost and high availability
    3. Narrows differential diagnosis by ruling out other causes
    4. Typically normal in first 2-3 weeks (esp. acute Osteomyelitis in Children)
  2. Osteomyelitis Bone Scan
    1. Low Test Specificity (can not distinguish Osteomyelitis from Trauma or recent post-surgical changes)
    2. Distinguishes Cellulitis from Osteomyelitis
    3. In combination with Leokocyte Scintigraphy, efficacy approaches that of MRI
      1. Consider in patients for whom MRI is contraindicated (e.g. due to Pacemaker)
  3. Osteomyelitis MRI
    1. Best Test Sensitivity and Specificity (except in region of surgical hardware)
    2. Best distinguishes soft tissue infection from bone infection and defines infection margins
  4. Osteomyelitis PET
    1. Very high Test Sensitivity and Test Specificity, but cost prohibitive
  5. Osteomyelitis CT
    1. Avoid for Osteomyelitis evaluation unless MRI contraindicated
    2. May also identify soft tissue abscess, gas formation, foreign bodies and bony destruction
  6. Bone Ultrasound Findings (may have niche applicability, such as in Sickle Cell Disease related Osteomyelitis)
    1. Bone abscess
    2. Periostitis

VII. Management

  1. See Osteomyelitis Management
  2. See Suspected Osteomyelitis in Diabetes Mellitus

VIII. References

  1. Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6
  2. Boutin (1998) Orthop Clin North Am 29:41-66 [PubMed]
  3. Carek (2001) Am Fam Physician 63(12):2413-20 [PubMed]
  4. Dirschl (1993) Drugs 45:29-43 [PubMed]
  5. Eckman (1995) JAMA 273:712-20 [PubMed]
  6. Haas (1996) Am J Med 101:550-61 [PubMed]
  7. Lew (1997) N Engl J Med 336:999-1007 [PubMed]
  8. Lipsky (1997) Clin Infect Dis 25:1318-26 [PubMed]

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Related Studies

Ontology: Osteomyelitis (C0029443)

Definition (NCI) An acute or chronic inflammation of the bone and its structures due to infection with pyogenic bacteria.
Definition (NCI_NCI-GLOSS) Inflammation of the bone caused by an infection, which may spread to the bone marrow and tissues near the bone. Osteomyelitis can cause severe pain in the infected bone. If it is not treated, it can kill bone tissue.
Definition (CSP) inflammation of the bone marrow and adjacent bone caused by a pyogenic organism; it may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum.
Concepts Disease or Syndrome (T047)
MSH D010019
ICD9 730.20, 730.2
ICD10 M86 , M86.9, M86.99
SnomedCT 203244005, 156801003, 203207005, 240141009, 268020008, 156810006, 203206001, 60168000
LNC LP128775-6, MTHU040697
English Osteomyelitides, Unspecified osteomyelitis, OSTEOMYELITIS, Unsp.osteomyelitis-site unspec, Unspecified osteomyelitis of unspecified site, Unspecified osteomyelitis, site unspecified, Osteomyelitis, unspecified, Unspecified osteomyelitis NOS, osteomyelitis (diagnosis), osteomyelitis, Osteomyelitis NOS, Osteomyelitis NOS-unspec, Osteomyelitis [Disease/Finding], bones infections, bone infection, a bacterial infection of the bone or bone marrow, bone infections, unspecified osteomyelitis, bones infection, Osteomyelitis, Unspecified osteomyelitis (disorder), Unspecified osteomyelitis NOS (disorder), Unspecified osteomyelitis of unspecified site (disorder), OM - Osteomyelitis, OSTM - Osteomyelitis, Osteomyelitis (disorder), Pyogenic inflammation of bone, Osteomyelitis, NOS, Pyogenic inflammation of bone, NOS, Osteomyelitis [Ambiguous]
French OSTEOMYELITE, Ostéomyélite SAI, Ostéomyélite non précisée, site non précisé, Ostéomyélite non précisée, Ostéomyélite
Portuguese OSTEOMIELITE, Osteomielite NE, Osteomielite NE de localização NE, Osteomielite
Spanish OSTEOMIELITIS, Osteomielitis NEOM, Osteomielitis no especificada, Osteomielitis no especificada, localización no especificada, osteomielitis no especificada, SAI (trastorno), osteomielitis no especificada, SAI, Unspecified osteomyelitis NOS, osteomielitis no especificada, de sitio no especificado (trastorno), osteomielitis, no especificada (trastorno), osteomielitis no especificada, de sitio no especificado, osteomielitis, no especificada, inflamación piógena del hueso, osteomielitis (trastorno), osteomielitis, Osteomielitis
German OSTEOMYELITIS, unspezifische Osteomyelitis, Stelle unspezifisch, unspezifische Osteomyelitis, Osteomyelitis NNB, Osteomyelitis, nicht naeher bezeichnet, Osteomyelitis, Knochenmarkentzündung
Dutch niet-gespecificeerde osteomyelitis, niet-gespecificeerde osteomyelitis, plaats niet-gespecificeerd, osteomyelitis NAO, Osteomyelitis, niet gespecificeerd, osteomyelitis, Myelitis, Osteo-, Osteomyelitis
Italian Osteomielite non specificata, sede non specificata, Osteomielite NAS, Osteomielite non specificata, Osteomielite
Japanese 骨髄炎, 詳細不明の骨髄炎、部位不明, 骨髄炎ＮＯＳ, 詳細不明の骨髄炎, ｺﾂｽﾞｲｴﾝ, ｺﾂｽﾞｲｴﾝNOS, ｼｮｳｻｲﾌﾒｲﾉｺﾂｽﾞｲｴﾝ, ｼｮｳｻｲﾌﾒｲﾉｺﾂｽﾞｲｴﾝﾌﾞｲﾌﾒｲ
Swedish Osteomyelit
Czech osteomyelitida, Blíže neurčená osteomyelitida, neurčené lokalizace, Osteomyelitida, Osteomyelitida NOS, Blíže neurčená osteomyelitida
Finnish Osteomyeliitti
Russian OSTEOMIELIT, ОСТЕОМИЕЛИТ
Korean 골수염, 상세불명의 골수염
Croatian OSTEOMIJELITIS
Polish Zapalenie kości i szpiku
Hungarian nem meghatározott osteomyelitis, Osteomyelitis, osteomyelitis k.m.n., Nem meghatározott osteomyelitis, hely nem meghatározott
Norwegian Osteomyelitt, Betennelse i bein og beinmarg, Betennelse i ben og benmarg
Derived from the NIH UMLS (Unified Medical Language System)

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