Contents
Etiology
- most commonly involves Staph. aureus, long bones, & population <15 or >50 y.o.
- consider Salmonella typhi in patients with sickle cell disease
- neonates and immuno-compromised patients are susceptible to gram-negative organisms
- acute (<10 days) vs. subacute (>10 days) vs. chronic
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Plain Film Findings of Osteomyelitis |
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1. Soft tissue swelling |
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2. Lytic bone destruction |
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3. Periosteal reaction |
Clinical Presentation
- acute: localized extremity pain, ± fever, 1 to 2 weeks after respiratory infection or infection at another non-bony site
- chronic: non-healing wound or ulcer with drainage ± constitutional symptoms
Investigations
- blood culture, aspirate cultures, ESR, CBC (leukocytosis)
- XR, bone scan (increased uptake), MRI most sensitive/specific
Management
- IV antibiotics, empiric therapy, adjust pending blood and aspirate cultures
- surgical decortication and drainage ± local antibiotics (i.e. antibiotic beads) if MRI suggests an abscess or if patient does not improve after 36 hrs. on IV antibiotics