Osteomyelitis physical examination

Osteomyelitis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]; Nate Michalak, B.A.,Seyedmahdi Pahlavani, M.D. [3]

Overview

Patients with acute osteomyelitis may present with fever, local swelling, redness, and tenderness. Patients with with chronic osteomyelitis may present with additional signs such as draining sinus tracts, unhealing ulcers, unhealing fractures, Brodie's abscess, and unstable joints in cases of infected prosthesis. Commonly affected bones include long bones and lumbar vertebrae in hematogenous osteomyelitis, hips, knees and elbows in contiguous-focus osteomyelitis, and bones of the feet in osteomyelitis secondary to vascular insufficiency.

Physical Examination

• Neonates might exhibit pseudoparalysis or pain with movement of the affected extremity (e.g., diaper changes). In children and adults, it depends on the site of involvement

Appearance of the Patient

Patients with osteomyelitis usually in pain, and they appear ill.

Vital Signs

• Fever

Acute Osteomyelitis

• Swelling
• Redness
• Tenderness (except in diabetic patients with advanced neuropathy)

Chronic Osteomyelitis

Patients with chronic osteomyelitis may present with acute signs in addition to the following:

• Draining sinus tract
• Unhealing ulcers, particularly those over bony prominences or any ulcer in which bone is palpable by blunt probe
• Unhealing fractures
• Unstable joint in patients with infection of their prosthesis.

Common Locations

Hematogenous Osteomyelitis

• Long bone metaphysis (typically tibia and femur) in children

• Presence of transphyseal blood vessels and an immature growth plate in infants increase the likelihood of the infection spreading to the epiphysis and joint cavity.

• Lumbar vertebrae in elderly patients

• Vertebral osteomyelitis involves adjacent vertebrae and intervertebral disc

Contiguous-focus Osteomyleitis

• Hip, knee, elbow, due to infection of prosthesis
• Long bones due to fracture

Osteomyelitis Secondary to Vascular Insufficiency

• Toes, metatarsal heads, and tarsal bones

Common sites of ostemyelitis in children include:

Sites of osteomyelitis in children	Prevalence
Femur	23-28%
Tibia	20-26%
Humerus	8-13%
Radius	5-6%
Phalanx	2-4%
Pelvis	5-9%
Calcaneus	4-6%
Ulna	5-6%
Metatarsal	~2%
Vertebrae	2-4%
Sacrum	~2%
Clavicle	1-2%
Skull	~1%

Gallery

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  Osteomyelitis. With permission from Dermatology Atlas.

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  Osteomyelitis. With permission from Dermatology Atlas.

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  Osteomyelitis. With permission from Dermatology Atlas.