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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