Orthopedics Book

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Chronic Osteomyelitis

Aka: Chronic Osteomyelitis, Subacute Osteomyelitis, Osteomyelitis in Adults, Non-Hematogenous Osteomyelitis
  1. See Also
    1. Osteomyelitis
    2. Acute Osteomyelitis
    3. Osteomyelitis Causes
  2. Pathophysiology
    1. Necrotic bone is identified on presentation (contrast with inflammation in Acute Osteomyelitis)
    2. Often polymicrobial infection (contrast with Acute Osteomyelitis, which is often monomicrobial)
  3. Findings: Symptoms and Signs
    1. Presentation may be delayed 6 weeks or more after symptom onset
    2. Fever is often absent
    3. Non-healing ulcers (necrotic tissue may be present within ulcer)
    4. Non-healing Fractures or wounds over surgical hardware or regions of Trauma
    5. Localized bone pain
    6. Erythema and swelling at affected area
    7. Draining sinus tracts
    8. Decreased range of motion of adjacent joints
    9. Diminished blood supply
  4. Types
    1. Open Fracture (27% Incidence of Osteomyelitis within 3 months)
    2. Contigiuous spread from soft tissue infection
      1. Associated with Diabetic Neuropathy and Peripheral Vascular Disease
    3. Hematogenous spread from bacteremia
      1. Much less common in adults than in children
      2. Vertebrae are most common locations for infection
        1. See Vertebral Osteomyelitis
        2. Presents with back pain
        3. Most common with IV Drug Abuse, Diabetes Mellitus, Chronic Kidney Disease, cancer
      3. Long bones, Pelvis and clavicle may also be affected
  5. Causes
    1. See Osteomyelitis Causes
  6. Differential Diagnosis
    1. See Osteomyelitis
  7. Labs
    1. See Osteomyelitis
  8. Imaging
    1. See Osteomyelitis
  9. Diagnosis
    1. Imaging (XRay, bone scan, MRI) demonstrates contiguous soft tissue infection or bony destruction
    2. Signs suggestive of contiguous Wound Infection spread to bone
      1. Exposed bone
      2. Persistent sinus tract
      3. Tissue necrosis over bone
      4. Chronic Wound overlying Fracture
      5. Chronic Wound overlying surgicl hardware
    3. Labs suggestive of inflammation or infection (sensitive but not specific, more useful in children)
      1. Blood Cultures positive (Test Sensitivity less than 50%)
      2. C-Reactive Protein (C-RP) increased
      3. Erythrocyte Sedimentation Rate (ESR)
    4. References
      1. Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
      2. American Society of Plastic Surgery Guidelines
        1. http://www.guideline.gov/content.aspx?id=11513
  10. Diagnosis: Most Predictive of Osteomyelitis
    1. Probe-to-Bone Test
    2. Skin Ulceration over a bony prominence
      1. Ulcer present over 2 weeks
      2. Ulcer over 2 cm in size
        1. Test Sensitivity: 56%
        2. Specificity: 92%
      3. Ulcer depth exceeds 3 mm
  11. Management
    1. See Osteomyelitis Management
  12. References
    1. Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
    2. Boutin (1998) Orthop Clin North Am 29:41-66 [PubMed]
    3. Bury (2021) Am Fam Physician 104(4): 395-402 [PubMed]
    4. Carek (2001) Am Fam Physician 63(12):2413-20 [PubMed]
    5. Dirschl (1993) Drugs 45:29-43 [PubMed]
    6. Eckman (1995) JAMA 273:712-20 [PubMed]
    7. Haas (1996) Am J Med 101:550-61 [PubMed]
    8. Lew (1997) N Engl J Med 336:999-1007 [PubMed]
    9. Lipsky (1997) Clin Infect Dis 25:1318-26 [PubMed]

Chronic osteomyelitis (C0008707)

Concepts Disease or Syndrome (T047)
ICD9 730.10, 730.1
SnomedCT 203205002, 203181001, 156791003, 156800002, 203183003, 40970001
English Chron.osteomyelitis-site unsp., Chronic osteomyelitis NOS, Chronic osteomyelitis of unspecified site, Chronic osteomyelitis, site unspecified, chronic osteomyelitis (diagnosis), chronic osteomyelitis, Osteomyelitis chronic NOS, Chr osteomyelitis-unsp, osteomyelitis chronic, Osteomyelitis;chronic, Chronic osteomyelitis NOS (disorder), Chronic osteomyelitis of unspecified site (disorder), Osteomyelitis chronic, Chronic osteomyelitis, Chronic osteomyelitis (disorder), chronic; osteomyelitis, osteomyelitis; chronic, Chronic osteomyelitis with or without periostitis, Chronic osteomyelitis, NOS, Chronic or old osteomyelitis with or without mention of periostitis
Italian Osteomielite cronica, Osteomielite cronica, sede non specificata, Osteomielite cronica NAS
Dutch osteomyelitis chronisch NAO, chronische osteomyelitis, plaats niet-gespecificeerd, chronische osteomyelitis, chronisch; osteomyelitis, osteomyelitis; chronisch, osteomyelitis chronisch
French Ostéomyélite chronique, site non précisé, Ostéomyélite chronique SAI, Ostéomyélite chronique
German Osteomyelitis chronisch NNB, chronische Osteomyelitis, Stelle unspezifisch, chronische Osteomyelitis
Portuguese Osteomielite crónica NE, Osteomielite crónica, localização NE, Osteomielite crónica
Spanish Osteomielitis crónica NEOM, Osteomielitis crónica, localización no especificada, Chronic osteomyelitis NOS, osteomielitis crónica, SAI (trastorno), osteomielitis crónica, de sitio no especificado (trastorno), osteomielitis crónica, de sitio no especificado, osteomielitis crónica, SAI, osteomielitis crónica (trastorno), osteomielitis crónica, Osteomielitis crónica
Japanese 慢性骨髄炎、部位不明, 慢性骨髄炎NOS, 慢性骨髄炎, マンセイコツズイエンNOS, マンセイコツズイエンブイフメイ, マンセイコツズイエン
Czech Chronická osteomyelitida NOS, Chronická osteomyelitida, Chronická osteomyelitida postihující blíže neurčenou část těla
Hungarian chronicus osteomyelitis, Chronicus osteomyelitis, hely nem meghatározott, Chronicus osteomyelitis k.m.n.
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Subacute osteomyelitis (C0410345)

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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