Osteomyelitis

Osteomyelitis should be suspected in those with a history of open fracture, recent orthopedic surgery, or a discharging sinus; in immunocompromised patients; or in unwell children.

Suggestive clinical features include fever, bone pain, and reduced mobility; local erythema, tenderness, warmth, and swelling; and reduced range of movement.

Plain radiographs provide a good initial imaging modality for screening acute and chronic osteomyelitis.

Magnetic resonance imaging (MRI) is the imaging modality with greatest sensitivity for diagnosing osteomyelitis.

The diagnosis should be confirmed by culture obtained from biopsy of the involved bone.

Ideally, microbiologic samples should be taken before giving empiric antibiotics. However, if the patient is septic or otherwise unwell, sampling should not delay the administration of antibiotics.

In chronic osteomyelitis, surgery to remove the dead bone is the primary treatment modality. Antibiotics alone cannot achieve a cure.

Osteomyelitis is an inflammatory condition of bone caused by an infecting organism, most commonly Staphylococcus aureus.[1]Glaudemans AWJM, Jutte PC, Cataldo MA, et al. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging. 2019 Apr;46(4):957-70. https://link.springer.com/article/10.1007/s00259-019-4262-x http://www.ncbi.nlm.nih.gov/pubmed/30675635?tool=bestpractice.com ​ It usually involves a single bone but may rarely affect multiple sites.

Severity can be staged depending on the etiology of the infection, its pathogenesis, the extent of bone involvement, duration, and host factors particular to the individual patient. Broadly, bone infection is either hematogenous (originating from bacteremia) or contiguous focus (originating from a focus of infection adjacent to the area of osteomyelitis). Despite these different causes all forms of acute osteomyelitis may evolve and become chronic, sharing a final common pathophysiology, with a compromised soft-tissue envelope surrounding dead, infected, and reactive new bone.[1]Glaudemans AWJM, Jutte PC, Cataldo MA, et al. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging. 2019 Apr;46(4):957-70. https://link.springer.com/article/10.1007/s00259-019-4262-x http://www.ncbi.nlm.nih.gov/pubmed/30675635?tool=bestpractice.com