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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
| | ==[[Osteomyelitis differential diagnosis|Differentiating Osteomyelitis from other Diseases]]== |
| :* Irritability
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| :* Malaise
| | ==[[Osteomyelitis epidemiology and demographics|Epidemiology and Demographics]]== |
| :* Restriction of movement (pseudoparalysis of limb in neonates)
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| :* Local edema, erythema, and tenderness
| | ==[[Osteomyelitis risk factors|Risk Factors]]== |
| * Hematogenous vertebral osteomyelitis
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| :* Insidious onset
| | ==[[Osteomyelitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| :* 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== | | ==Diagnosis== |
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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" />.
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| | [[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]] |
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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.
| | ==Case Studies== |
| <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> | | [[Osteomyelitis case study one|Case #1]] |
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| ==References== | | ==Related Chapters== |
| {{Reflist|2}}
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| ==See also==
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| *[[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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