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Osteomyelitis

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  1. Classification: Waldvogel System
    1. Acute Osteomyelitis: Hematogenous Seeding
      1. Child with long bone metaphysis infection
    2. Chronic osteomyelitis: Wound associated
      1. Adult with open injury to bone and soft tissue
    3. Contiguous spread of infection
      1. No generalized vascular disease
      2. Generalized vascular disease
  2. Etiology
    1. See Osteomyelitis Causes
  3. Symptoms and Signs: Acute Osteomyelitis
    1. Presentation within one week of symptom onset
    2. Local signs of infection
      1. Tenderness on palpation over involved bone
      2. Decreased range of motion of adjacent joints
    3. Systemic signs of infection
      1. Fever
      2. Irritability or lethargy
  4. Symptoms and Signs: Chronic and Subacute Osteomyelitis
    1. Localized bone pain
    2. Erythema and swelling at affected area
    3. Draining sinus tracts
    4. Decreased range of motion of adjacent joints
    5. Diminished blood supply
  5. Signs 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
  6. Labs
    1. Complete Blood Count (CBC)
      1. Leukocytosis
    2. Erythrocyte Sedimentation Rate (ESR) exceeds 70
      1. Test Sensitivity: 28%
    3. C-Reactive Protein (CRP)
    4. Bone Biopsy (Gold Standard)
      1. Test Sensitivity: 95%
      2. Specificity: 99%
  7. Radiology
    1. Bone XRay
      1. Findings
        1. Osteolysis
        2. Periosteal reaction
        3. Sequestra (islands of necrotic bone)
        4. Bone abscess (Brodie's abscess)
      2. Efficacy
        1. Test Sensitivity: 62%
        2. Specificity: 64%
      3. Limitations
        1. Bone changes lag infection by 10-20 days
        2. XRay changes not seen until 40-70% bone resorbed
    2. Bone Scan with Technetium-99m
      1. Differential Diagnosis of Osteomyelitis on bone scan
        1. Soft Tissue infection
        2. Neurotrophic lesion
        3. Gouty Arthritis
        4. Degenerative Joint Disease
        5. Postsurgical change
        6. Healing Fracture or Stress Fracture
        7. Noninfectious Inflammation
      2. Efficacy
        1. Test Sensitivity: 86%
        2. Specificity: 45%
        3. Abnormal uptake seen 2 weeks before XRay changes
    3. Indium-111-labeled Leukocyte scanning
      1. Sensitivity: 89%
      2. Specificity: 79%
    4. Bone MRI
      1. Test Sensitivity: 99%
      2. Test Specificity: 81%
      3. False positives with Osteoarthropathy
    5. Bone Ultrasound Findings
      1. Bone abscess
      2. Periostitis
    6. Bone CT Findings
      1. Cortical Bone osteolysis
      2. Small gas foci
      3. Foreign body
  8. Management
    1. See Osteomyelitis Management
    2. See Suspected Osteomyelitis in Diabetes Mellitus
  9. References
    1. Boutin (1998) Orthop Clin North Am 29:41
    2. Carek (2001) Am Fam Physician 63(12):2413
    3. Dirschl (1993) Drugs 45:29
    4. Eckman (1995) JAMA 273:712
    5. Haas (1996) Am J Med 101:550
    6. Lew (1997) N Engl J Med 336:999
    7. Lipsky (1997) Clin Infect Dis 25:1318

Osteomyelitis (C0029443)

Definition (CSP)inflammation of the bone marrow and adjacent bone caused by a pyogenic organism; it may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum.
ConceptsDisease or Syndrome (T047)
ICD9730.2, 730.20, 730.9, 730.90
EnglishBone infection, Infection of bone, Osteomyelitides, Osteomyelitis, Pyogenic inflammation of bone, Unspecified infection of bone, Unspecified osteomyelitis, Unspecified osteomyelitis of unspecified site
Spanishinfección ósea, infección de hueso, infección del hueso, infeccion de hueso, infeccion del hueso, infeccion osea, inflamación piógena del hueso, inflamacion piogena del hueso, osteomielitis
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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