ID
Osteomyelitis
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Osteomyelitis
Classification
Waldvogel System
Acute Osteomyelitis
: Hematogenous Seeding
Child with long bone metaphysis infection
Chronic Osteomyelitis
:
Wound
associated
Adult with open injury to bone and soft tissue
Contiguous spread of infection
No generalized vascular disease
Gene
ralized vascular disease
Causes
See
Osteomyelitis Causes
Types
Acute Osteomyelitis
Typical case is a 1-2 week history of fever,
Joint Pain
in the long bone of a child (hematogenous spread)
Chronic Osteomyelitis
Typical case is a 4-6 week history of malaise, regional pain at an open wound in an adult (contiguous spread)
Labs
Inflammation markers
Gene
ral
More useful in children, especially in ruling out Osteomyelitis (serial negative markers)
Sensitive, but not specific
Complete Blood Count
(CBC)
Leukocytosis
Erythrocyte Sedimentation Rate
(ESR) exceeds 70
Test Sensitivity
: 28%
C-Reactive Protein
(CRP)
Bone Biopsy (Gold Standard)
Test Sensitivity
: 95%
Specificity
: 99%
Polymicrobial infections are more common in
Chronic Osteomyelitis
Consider specific testing in atypical cases (e.g.
Mycobacterium tuberculosis
)
Blood Culture
Test Sensitivity
: <50%
Positive
Blood Culture
with clinical findings suggestive of Osteomyelitis may obviate the need for bone culture
Superficial wound culture
Not recommended due to contamination
Imaging
Osteomyelitis XRay
Typical appearance is the "rat bite" of destroyed bony cortex
First line study due to low cost and high availability
Narrows differential diagnosis by ruling out other causes
Typically normal in first 2-3 weeks (esp. acute
Osteomyelitis in Children
)
Osteomyelitis Bone Scan
Low
Test Specificity
(can not distinguish Osteomyelitis from
Trauma
or recent post-surgical changes)
Distinguishes
Cellulitis
from Osteomyelitis
In combination with Leokocyte Scintigraphy, efficacy approaches that of MRI
Consider in patients for whom MRI is contraindicated (e.g. due to
Pacemaker
)
Osteomyelitis MRI
Best
Test Sensitivity
and
Specificity
(except in region of surgical hardware)
Best distinguishes soft tissue infection from bone infection and defines infection margins
Osteomyelitis PET
Very high
Test Sensitivity
and
Test Specificity
, but cost prohibitive
Osteomyelitis CT
Avoid for Osteomyelitis evaluation unless MRI contraindicated
May also identify soft tissue abscess, gas formation, foreign bodies and bony destruction
Bone
Ultrasound
Findings (may have niche applicability, such as in
Sickle Cell Disease
related Osteomyelitis)
Bone abscess
Periostitis
Management
See
Osteomyelitis Management
See
Suspected Osteomyelitis in Diabetes Mellitus
References
Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6
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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