Osteomyelitis

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

Suspect chronic osteomyelitis most commonly in adults with a history of open fracture, previous orthopaedic surgery, or a discharging sinus.

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

Consider native vertebral osteomyelitis in a patient with new back pain and systemic symptoms.

Request plain x-rays to screen for 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. There is limited value in surface or sinus swabs.

Aim to take microbiological samples before giving empirical antibiotics. However, if the patient is septic or otherwise unwell, sampling should not delay the administration of antibiotics.

In chronic osteomyelitis, surgery to remove necrotic bone is the primary treatment. 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. It may occur in the peripheral or axial skeleton. Severity can be staged depending on the aetiology of the infection, its pathogenesis, extent of bone involvement, duration, and host factors particular to the individual patient. Broadly, bone infection is either haematogenous or contiguous-focus. Despite these different causes, all forms of acute osteomyelitis may evolve and become chronic, sharing a final common pathophysiology, with compromised soft tissue 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

This topic does not cover babies under 3 months of age.