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| Image = Ostermyelitis Tibia.jpg | | | Image = Ostermyelitis Tibia.jpg | |
| Caption = Osteomyelitis of the [[tibia]] of a young child. Numerous [[abscess]]es in the bone show as radiolucency. | | | Caption = Osteomyelitis of the [[tibia]] of a young child. Numerous [[abscess]]es in the bone show as radiolucency. | |
| ICD10 = {{ICD10|M|86||m|86}} |
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| ICD9 = {{ICD9|730}} |
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| ICDO = |
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| OMIM = |
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| DiseasesDB = 9367 |
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| MedlinePlus = 000437 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D010019 |
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| }} | | }} |
| {{Osteomyelitis}} | | {{Osteomyelitis}} |
| {{CMG}}'''; Associate Editor(s)-In-Chief:''' {{CZ}} | | {{CMG}}; {{AE}} {{MehdiP}},{{NRM}} |
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| | {{SK}} OM |
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| == Presentation == | | ==[[Osteomyelitis overview|Overview]]== |
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| Generally, microorganisms may infect bone through one or more of three basic methods: via the [[bloodstream]], contiguously from local areas of infection (as in [[cellulitis]]), or penetrating [[Physical trauma|trauma]], including [[iatrogenic]] causes such as [[joint replacement]]s or internal fixation of [[Bone fracture|fracture]]s or [[endodontic therapy|root-canaled]] teeth.<ref name="Robbins" /> Once the bone is infected, [[leukocyte]]s enter the infected area, and in their attempt to [[phagocytosis|engulf]] the infectious organisms, release [[enzyme]]s that [[Lysis|lyse]] the bone. [[Pus]] spreads into the bone's blood vessels, impairing their flow, and areas of devitalized infected bone, known as ''sequestra'', form the basis of a chronic infection.<ref name="Robbins" /> Often, the body will try to create new bone around the area of [[necrosis]]. The resulting new bone is often called an [[involucrum]].<ref name="Robbins" /> On [[histology|histologic]] examination, these areas of necrotic bone are the basis for distinguishing between ''[[Acute (medicine)|acute]] osteomyelitis'' and ''[[wikt:chronic|chronic]] osteomyelitis''. Osteomyelitis is an infective process which encompasses all of the bone ([[wikt:osseous|osseous]]) components, including the bone marrow. When it is chronic it can lead to bone [[sclerosis]] and deformity.
| | ==[[Osteomyelitis historical perspective|Historical Perspective]]== |
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| In [[infant]]s, the infection can spread to the [[joint]] and cause [[arthritis]]. In children, large subperiosteal abscesses can form because the [[periosteum]] is loosely attached to the surface of the bone.<ref name="Robbins" />
| | ==[[Osteomyelitis classification|Classification]]== |
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| Because of the particulars of their blood supply, the [[tibia]], [[femur]], [[humerus]], [[vertebra]], the [[maxilla]], and the mandibular bodies are especially susceptible to osteomyelitis.<ref>{{cite web
| | ==[[Osteomyelitis pathophysiology|Pathophysiology]]== |
| | url = http://www.emedicine.com/emerg/topic349.htm
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| | title = Osteomyelitis
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| | accessdate = 2007-11-11
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| | author = King MD, Randall W.
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| | coauthors = David Johnson, MD, FACEP
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| | date = 2006-07-13
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| | work = [[eMedicine]] | |
| | publisher = [[WebMD]]
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| }}</ref> However, abscesses of any bone may be precipitated by trauma to the affected area. Many infections are caused by ''[[Staphylococcus aureus]]'', a member of the normal [[flora (microbiology)|flora]] found on the [[skin]] and [[mucous membrane]]s.
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| * Hematogenous long-bone osteomyelitis
| | ==[[Osteomyelitis causes|Causes]]== |
| :* Abrupt onset of high fever (fever is present in only 50% of neonates with osteomyelitis)
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| :* Fatigue
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| :* Irritability
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| :* Malaise
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| :* Restriction of movement (pseudoparalysis of limb in neonates)
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| :* Local edema, erythema, and tenderness
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| * Hematogenous vertebral osteomyelitis
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| :* Insidious onset
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| :* History of an acute bacteremic episode
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| :* May be associated with contiguous vascular insufficiency
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| :* Local edema, erythema, and tenderness
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| :* Failure of a young child to sit up normally2
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| * Chronic osteomyelitis
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| :* Non-healing ulcer
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| :* Sinus tract drainage
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| :* Chronic fatigue
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| :* Malaise
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| ==Diagnosis== | | ==[[Osteomyelitis differential diagnosis|Differentiating Osteomyelitis from other Diseases]]== |
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| Diagnosis of osteomyelitis is often based on [[radiology|radiologic]] results showing a [[lytic]] center with a ring of [[sclerosis]], though bone cultures are normally required to identify the specific pathogen<ref name="Robbins" />.
| | ==[[Osteomyelitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Diagnostic Findings== | | ==[[Osteomyelitis risk factors|Risk Factors]]== |
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| *Conventional radiographic evaluation of acute osteomyelitis is insufficient because bone changes are not evident for 14–21 days after the onset of infection.
| | ==[[Osteomyelitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *Although MR imaging is the accepted modality of choice for the early detection and surgical localization of osteomyelitis, in the emergency department, CT is usually more readily available for establishing the diagnosis. <ref>Laura M. Fayad, John A. Carrino, and Elliot K. Fishman. [http://radiographics.rsnajnls.org/cgi/content/abstract/27/6/1723 Musculoskeletal Infection: Role of CT in the Emergency Department.] RadioGraphics 2007 27: 1723-1736.</ref>
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| *At CT, features of bacterial osteomyelitis include overlying soft-tissue swelling, periosteal reaction, medullary low-attenuation areas or trabecular coarsening, and focal cortical erosions.
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| ===MRI=== | | ==Diagnosis== |
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| '''Patient #1 Extensive calcaneal osteomyelitis. Note soft tissue ulceration and [[cellulitis]]'''
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| <gallery>
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| Image:Osteomyelitis MRI 001.jpg|T1
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| Image:Osteomyelitis MRI 002.jpg|STIR
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| Image:Osteomyelitis MRI 003.jpg|T1
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| Image:Osteomyelitis MRI 004.jpg|STIR
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| Image:Osteomyelitis MRI 005.jpg|T1 fat sat contrast
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| Image:Osteomyelitis MRI 006.jpg|T1 fat sat contrast
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| </gallery>
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| ===Bone Scan===
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| '''Patient #2'''
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| <gallery>
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| Image:Osteomyelitis-102.jpg|Blood pool
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| Image:Osteomyelitis-103.jpg|Delayed
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| </gallery>
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| <br clear="left"/>
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| {{#ev:youtube|X2ShDUfeso0}}
| | [[Osteomyelitis history and symptoms|History and Symptoms]] | [[Osteomyelitis physical examination|Physical Examination]] | [[Osteomyelitis laboratory findings|Laboratory Findings]] | [[Osteomyelitis x ray|X Ray]] | [[Osteomyelitis CT|CT]] | [[Osteomyelitis MRI|MRI]] | [[Osteomyelitis other imaging findings|Other Imaging Findings]] | [[Osteomyelitis other diagnostic studies|Other Diagnostic Studies]] |
| <br clear="left"/>
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| ==Treatment== | | ==Treatment== |
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| Osteomyelitis often requires prolonged [[antibiotic]] therapy, with a course lasting a matter of weeks or months. A [[PICC line]] or [[central venous catheter]] is often placed for this purpose. Osteomyelitis also may require surgical [[debridement]]. Severe cases may lead to the loss of a limb. Initial first line antibiotic choice is determined by the patient's history and regional differences in common infective organisms.
| | [[Osteomyelitis medical therapy|Medical Therapy]] | [[Osteomyelitis surgery|Surgery]] | [[Osteomyelitis prevention|Prevention]] | [[Osteomyelitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Osteomyelitis future or investigational therapies|Future or Investigational Therapies]] |
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| Prior to the widespread availability and use of antibiotics, [[maggot|blow fly larvae]] were sometimes [[maggot therapy|deliberately introduced]] to the wounds to feed on the infected material, effectively scouring them clean.
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| <ref>{{cite journal |last=Baer M.D. |first=William S. |year=1931 |title=The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blow Fly) |journal=Journal of Bone and Joint Surgery |volume=13 |pages=438–475 |url=http://www.ejbjs.org/cgi/content/abstract/13/3/438 |accessdate= 2007-11-12}}</ref><ref>{{cite journal
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| | quotes = yes
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| | last=McKeever
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| | first=Duncan Clark
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| | year=2008|month=June
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| | title=The classic: maggots in treatment of osteomyelitis: a simple inexpensive method. 1933
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| | journal=Clin. Orthop. Relat. Res.
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| | volume=466
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| | issue=6
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| | pages=1329–35
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| | pmid = 18404291
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| | doi = 10.1007/s11999-008-0240-5
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| }}</ref>
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| [[Hyperbaric oxygen therapy]] has been shown to be a useful [[wikt:adjunct|adjunct]] to the treatment of [[wikt:refractory|refractory]] osteomyelitis.<ref>{{cite journal |author=Mader JT, Adams KR, Sutton TE |title=Infectious diseases: pathophysiology and mechanisms of hyperbaric oxygen |journal=J. Hyperbaric Med |volume=2 |issue=3 |pages=133–140 |year=1987 |url=http://archive.rubicon-foundation.org/4339 |accessdate=2008-05-16}}</ref><ref>{{cite journal |author=Kawashima M, Tamura H, Nagayoshi I, Takao K, Yoshida K, Yamaguchi T |title=Hyperbaric oxygen therapy in orthopedic conditions |journal=Undersea Hyperb Med |volume=31 |issue=1 |pages=155–62 |year=2004 |pmid=15233171 |url=http://archive.rubicon-foundation.org/4000 |accessdate=2008-05-16}}</ref> A treatment lasting 42 days is practiced in a number of facilities.<ref>Putland M.D, Michael S., Hyperbaric Medicine, Capital Regional Medical Center, Tallahassee, Florida, personal inquiry June 2008.</ref>
| | ==Case Studies== |
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| ==References==
| | [[Osteomyelitis case study one|Case #1]] |
| {{Reflist|2}}
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| ==See also== | | ==Related Chapters== |
| *[[Brodie abscess]] | | *[[Brodie abscess]] |
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| ==External Links==
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| * [http://goldminer.arrs.org/search.php?query=Osteomyelitis Goldminer: Osteomyelitis]
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| ==Additional Resources==
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| * {{MerckManual|5|54|b}}
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| * {{Chorus|00298}}
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| {{Diseases of the musculoskeletal system and connective tissue}} | | {{Diseases of the musculoskeletal system and connective tissue}} |
| [[Category:Orthopedics]]
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| [[Category:Bacterial diseases]]
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| [[Category:Skeletal disorders]]
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| [[Category:Infectious disease]]
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| [[Category:Overview complete]]
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| [[de:Osteomyelitis]] | | [[de:Osteomyelitis]] |
| [[fr:Ostéomyélite]] | | [[fr:Ostéomyélite]] |
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| [[pt:Osteomielite]] | | [[pt:Osteomielite]] |
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