Osteomyelitis

Suspect osteomyelitis in those with a history of open fracture, recent orthopedic surgery, or a discharging sinus; in the immunocompromised patient; or in the unwell child.

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

Magnetic resonance imaging and computed tomography (CT) may be used to determine diagnosis and treatment decisions. In some cases positron emission tomography/CT or single-photon emission computed tomography/CT may have a role.

Diagnosis must be confirmed using deep microbiologic samples via radiologic guided biopsy or open surgery.

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

Giving empiric antibiotics without microbiologic sampling should be avoided, with the exception of patients who are septic and unwell. Even then, blood cultures should be taken before antibiotics are given.

Only cultures from deep sites are reliable. There is no value in surface or sinus swabs.

Osteomyelitis is an inflammatory condition of bone caused by an infecting organism, most commonly Staphylococcus aureus. 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.