Orthopedics Book

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Osteomyelitis Management in Diabetes MellitusAka: Suspected Osteomyelitis in Diabetes Mellitus, Diabetes Mellitus Associated Osteomyelitis

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  1. See Also
    1. Osteomyelitis
    2. Osteomyelitis Management
  2. Differential Diagnosis
    1. Cellulitis
    2. Charcot Foot
  3. Evaluation
    1. Classification of Diabetic Foot Ulcer
      1. See Wagner Ulcer Classification
      2. See University of Texas Diabetic Wound Classification
    2. Bone Visualized or Probe-to-Bone Test positive
      1. Treat as presumptive Osteomyelitis
    3. Bone XRay consistent with Osteomyelitis
      1. Treat as presumptive Osteomyelitis
    4. Bone XRay not consistent with Osteomyelitis
      1. Severe Peripheral Neuropathy or high suspicion
        1. Obtain Indium-111 Leukocyte scan or Bone MRI
          1. Positive: Treat as presumptive Osteomyelitis
          2. Negative: Treat as Soft Tissue infection
      2. Lower suspicion for Osteomyelitis
        1. Treat as Soft Tissue Infection
  4. Management: Antibiotic Protocols
    1. Presumptive Osteomyelitis
      1. Consider bone biopsy for culture and pathology
      2. Consider bone resection with 2 weeks antibiotics
      3. Culture guided antibiotic therapy for 4-6 weeks
    2. Soft Tissue Infection
      1. See Cellulitis
      2. Soft tissue culture guided antibiotics for 2 weeks
  5. References
    1. Lipsky (1997) Clin Infect Dis 25:1321

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