Highlights & Basics
- Osteomyelitis should be suspected in those with a history of open fracture, recent orthopedic surgery, or a discharging sinus; in immunocompromised patients; or in unwell children.
- Suggestive clinical features include fever, bone pain, and reduced mobility; local erythema, tenderness, warmth, and swelling; and reduced range of movement.
- Plain radiographs provide a good initial imaging modality for screening 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.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
A 62-year-old man suffered an open tibial fracture, which became infected after internal fixation. He continued with intermittent discharge of pus from the front of his tibia for 21 years. Imaging confirmed the presence of chronic osteomyelitis with a central area of dead bone (sequestrum)
Plain x-ray of the left femur showing a lytic lesion in the medullary canal along with a "fallen leaf" sign with intramedullary sequestrum noted in the cavity
Citations
Woods CR, Bradley JS, Chatterjee A, et al. Clinical practice guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatric Infect Dis Soc. 2021 Sep 23;10(8):801-44.[Abstract][Full Text]
Berbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015 Sep 15;61(6):e26-46.[Abstract][Full Text]
Lipsky BA, Senneville É, Abbas ZG, et al; International Working Group on the Diabetic Foot (IWGDF). Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3280.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].[Full Text]
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