Last reviewed: 25 Jun 2021
Last updated: 24 Mar 2021

Summary

Definition

History and exam

Key diagnostic factors

  • nonspecific pain at site of infection
  • malaise and fatigue
  • local inflammation, erythema, or swelling
  • low-grade fever

Other diagnostic factors

  • sinus and/or wound drainage
  • scars, previous flaps
  • reduced range of movement
  • reduced sensation in diabetic foot ulcer
  • urinary tract symptoms
  • torticollis
  • limb deformity
  • tenderness to percussion

Risk factors

  • penetrating injuries
  • surgical contamination
  • intravenous drug misuse
  • diabetes mellitus
  • periodontitis

Diagnostic investigations

1st investigations to order

  • WBC count
  • erythrocyte sedimentation rate
  • CRP
  • plain x-rays of affected area
  • blood culture

Investigations to consider

  • guided bone biopsy or open bone biopsy
  • ultrasound
  • MRI of bone
  • CT scan
  • radionuclide scans
  • histology

Treatment algorithm

Contributors

Authors

Adrian Kendal, MA, BMBCh, DPhil, FRCS (Ortho)

Honorary Departmental Clinical Research Fellow

The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences

Oxford

UK

Disclosures

AK declares that he has no competing interests.

Jamie Ferguson, MB ChB (hons), MEd., FRCS (Orth)

Consultant in Trauma and Reconstruction Surgery

The Bone Infection Unit

Nuffield Orthopaedic Centre

Oxford University Hospitals Foundation NHS Trust

Oxford

UK

Disclosures

JF received a research grant in 2013 from Bonesupport AB, Lund, Sweden to collect data for a study on antibiotic carriers in osteomyelitis treatment. JF is an author of a number of references cited in this topic.

Tse Hua Nicholas Wong, BSc, MB BS, DPhil, MRCP, FRCPath

Consultant in Infectious Diseases and Microbiology

Buckinghamshire Healthcare NHS Trust

Aylesbury

UK

Disclosures

THNW declares that he has no competing interests.

Bridget L. Atkins, MA, MBBS, MSc, FRCPath, FRCP

Consultant

Infectious Diseases, Microbiology and Bone Infection

Oxford University Hospitals NHS Foundation Trust

Oxford

UK

Disclosures

BLA is an author of a number of references cited in this topic.

Martin McNally, MB, BCh, MD, FRCSEd, FRCS(Orth)

King James IV Professor and Consultant in Limb Reconstruction

Consultant in Limb Reconstruction

The Bone Infection Unit

Nuffield Orthopaedic Centre

Oxford University Hospitals Foundation NHS Trust

Oxford

UK

Disclosures

MM is an executive board member of the European Bone & Joint Infection Society and the Girdlestone Orthopaedic Society. He has performed consultancy work for Bonesupport AB and the Oxford Bone Infection Consultancy. He has received travel expenses from Bonesupport AB and the AO Foundation to attend scientific conferences and symposia. He has received royalties from Oxford University Press for contributions to textbooks. MM is an author of a number of references cited in this topic.

Acknowledgements

Dr Jamie Ferguson, Dr Tse Hua Nicholas Wong, Dr Bridget L. Atkins, Dr Martin McNally, and Mr Adrian Kendal wish to gratefully acknowledge Dr Jason H. Calhoun, Dr Nalini Rao, and Dr M. M. Manring, previous contributors to this topic. JHC, NR, and MMM declare that they have no competing interests.

Peer reviewers

Kristine Johnson, MD

Assistant Professor

Infectious Diseases

Bayview Medical Center

Baltimore

MD

Disclosures

KJ declares that she has no competing interests.

Silvano Esposito, MD

Associate Professor

Department of Infectious Diseases

University of Naples

Naples

Italy

Disclosures

SE has been reimbursed for attending several conferences and received fees for speaking and running educational programs by Pfizer, Novartis, Wyeth Lederle, Sanofi Aventis, and GSK.

Edward Pesanti, MD

Professor of Medicine

Infectious Diseases Division

University of Connecticut Health Center

Hartford

CT

Disclosures

EP declares that he has no competing interests.

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