II. Pathophysiology

  1. Necrotic bone is identified on presentation (contrast with inflammation in Acute Osteomyelitis)

III. Symptoms and signs

  1. Presentation may be delayed 6 weeks or more after symptom onset
  2. Localized bone pain
  3. Erythema and swelling at affected area
  4. Draining sinus tracts
  5. Decreased range of motion of adjacent joints
  6. Diminished blood supply

IV. Types

  1. Open Fracture (27% Incidence of Osteomyelitis within 3 months)
  2. Contigiuous spread from soft tissue infection
    1. Associated with Diabetic Neuropathy and Peripheral Vascular Disease
  3. Hematogenous spread from bacteremia
    1. Much less common in adults than in children
    2. Vertebrae are most common locations for infection
      1. See Vertebral Osteomyelitis
      2. Presents with back pain
      3. Most common with IV Drug Abuse, Diabetes Mellitus, Chronic Kidney Disease, cancer
    3. Long bones, Pelvis and clavicle may also be affected

V. Labs

VI. Imaging

VII. Diagnosis

  1. Imaging (XRay, bone scan, MRI) demonstrates contiguous soft tissue infection or bony destruction
  2. Signs suggestive of contiguous Wound Infection spread to bone
    1. Exposed bone
    2. Persistent sinus tract
    3. Tissue necrosis over bone
    4. Chronic Wound overlying Fracture
    5. Chronic Wound overlying surgicl hardware
  3. Labs suggestive of inflammation or infection (sensitive but not specific, more useful in children)
    1. Blood Cultures positive (Test Sensitivity less than 50%)
    2. C-Reactive Protein (C-RP) increased
    3. Erythrocyte Sedimentation Rate (ESR)
  4. References
    1. Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
    2. American Society of Plastic Surgery Guidelines
      1. http://www.guideline.gov/content.aspx?id=11513

VIII. Diagnosis: Most Predictive of Osteomyelitis

  1. Probe-to-Bone Test
  2. Skin Ulceration over a bony prominence
    1. Ulcer present over 2 weeks
    2. Ulcer over 2 cm in size
      1. Test Sensitivity: 56%
      2. Specificity: 92%
    3. Ulcer depth exceeds 3 mm

IX. Management

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Ontology: Subacute osteomyelitis (C0410345)

Concepts Disease or Syndrome (T047)
ICD10 M86.2 , M86.20, M86.29
SnomedCT 203301008, 67322009
German Subakute Osteomyelitis
Korean 아급성 골수염
English Subacute osteomyelitis, unspecified site, Subacute osteomyelitis, site unspecified, osteomyelitis subacute, osteomyelitis subacute (diagnosis), Subacute osteomyelitis with or without periostitis, Subacute osteomyelitis, Subacute osteomyelitis (disorder), osteomyelitis; subacute, subacute; osteomyelitis
Dutch osteomyelitis; subacuut, subacuut; osteomyelitis, Subacute osteomyelitis
Spanish osteomielitis subaguda (trastorno), osteomielitis subaguda con o sin periostitis, osteomielitis subaguda