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== History and Symptoms ==


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. 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. Often, the body will try to create new bone around the area of [[necrosis]]. The resulting new bone is often called an [[involucrum]]. 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.
==Overview==
The patient's history is important in establishing a diagnosis of osteomyelitis. Common history findings include [[intravenous drug use]], [[bacteremia]], recent open [[fracture]] or [[surgery]], and [[diabetes]]. Common symptoms include [[chills]], [[fever]], [[malaise]], local pain and warmth, [[edema]], and [[erythema]]. Fever is typically absent in diabetic patients with osteomyelitis secondary to vascular insufficiency and in patients with infected [[prosthesis]]. The presence of a '''draining sinus tract''' is pathognomonic of chronic osteomyelitis.


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.
==History and Symptoms==
===Patient History===
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient based on specific types of osteomyelitis include:
*Hematogenous Osteomyelitis:
:*[[Intravenous drug use]]<ref name="LewWaldvogel1997">{{cite journal|last1=Lew|first1=Daniel P.|last2=Waldvogel|first2=Francis A.|title=Osteomyelitis|journal=New England Journal of Medicine|volume=336|issue=14|year=1997|pages=999–1007|issn=0028-4793|doi=10.1056/NEJM199704033361406}}</ref>
:*[[Urinary catheter]] use
:*[[Bacteremia]]


Because of the particulars of their blood supply, the [[tibia]], [[femur]], [[humerus]], [[vertebra]], the [[maxilla]], and the mandibular bodies are especially susceptible to osteomyelitis. 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.
*Contiguous-focus Osteomyelitis:
:*Recent open [[fracture]]
:*Recent [[surgery]], especially [[orthopedic surgery]]
:*[[Prosthesis]]


* Hematogenous long-bone osteomyelitis
*Osteomyelitis secondary to vascular insufficiency:
:* Abrupt onset of high [[fever]] (fever is present in only 50% of neonates with osteomyelitis)
:*[[Diabetes]]<ref name="CaputoCavanagh1994">{{cite journal|last1=Caputo|first1=Gregory M.|last2=Cavanagh|first2=Peter R.|last3=Ulbrecht|first3=Jan S.|last4=Gibbons|first4=Gary W.|last5=Karchmer|first5=Adolf W.|title=Assessment and Management of Foot Disease in Patients with Diabetes|journal=New England Journal of Medicine|volume=331|issue=13|year=1994|pages=854–860|issn=0028-4793|doi=10.1056/NEJM199409293311307}}</ref>
:* [[Fatigue]]
:*Diabetic patients with soft-tissue inflammation or skin [[ulcers]] in the feet
:* [[Irritability]]
 
:* [[Malaise]]
===Common symptoms===
:* Restriction of movement (pseudoparalysis of limb in neonates)
*Systemic:<ref name="LewWaldvogel2004">{{cite journal|last1=Lew|first1=Daniel P|last2=Waldvogel|first2=Francis A|title=Osteomyelitis|journal=The Lancet|volume=364|issue=9431|year=2004|pages=369–379|issn=01406736|doi=10.1016/S0140-6736(04)16727-5}}</ref><ref name="pmid11880745">{{cite journal |vauthors=Vazquez M |title=Osteomyelitis in children |journal=Curr. Opin. Pediatr. |volume=14 |issue=1 |pages=112–5 |year=2002 |pmid=11880745 |doi= |url=}}</ref>
:* Local [[edema]], erythema, and tenderness
:*[[Chills]]
* Hematogenous vertebral osteomyelitis
:*[[Headache]]
:* Insidious onset
:*[[Fatigue]]
:* History of an acute bacteremic episode
:*[[Anorexia]]
:* May be associated with contiguous vascular insufficiency
:*[[Fever]]
:* Local edema, erythema, and tenderness
:*[[Malaise]]
:* Failure of a young child to sit up normally2
*Local:
* Chronic osteomyelitis
:*Pain
:* Non-healing ulcer
:*[[Edema]]
:* Sinus tract drainage
:*[[Erythema]]
:* Chronic fatigue
:*Warmth
:* Malaise
 
===Special Considerations===
*Diabetic patients with osteomyelitis secondary to [[vascular insufficiency]] typically do not have fever or inflammation.<ref name="pmid1908030">{{cite journal |vauthors=Newman LG, Waller J, Palestro CJ, Schwartz M, Klein MJ, Hermann G, Harrington E, Harrington M, Roman SH, Stagnaro-Green A |title=Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline |journal=JAMA |volume=266 |issue=9 |pages=1246–51 |year=1991 |pmid=1908030 |doi= |url=}}</ref>
*Diabetic patients with advanced [[neuropathy]] may not feel pain.
*Fever is typically absent in patients with infected prosthesis.
*Patients with vertebral osteomyelitis may have generalized neck and back pain.
*The presence of a '''draining sinus tract''' is '''pathognomonic''' of chronic osteomyelitis.


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
[[Category:Needs overview]]
[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Bacterial diseases]]
[[Category:Emergency mdicine]]
[[Category:Skeletal disorders]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Disease]]
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Latest revision as of 23:28, 29 July 2020

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

Overview

The patient's history is important in establishing a diagnosis of osteomyelitis. Common history findings include intravenous drug use, bacteremia, recent open fracture or surgery, and diabetes. Common symptoms include chills, fever, malaise, local pain and warmth, edema, and erythema. Fever is typically absent in diabetic patients with osteomyelitis secondary to vascular insufficiency and in patients with infected prosthesis. The presence of a draining sinus tract is pathognomonic of chronic osteomyelitis.

History and Symptoms

Patient History

A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient based on specific types of osteomyelitis include:

  • Hematogenous Osteomyelitis:
  • Contiguous-focus Osteomyelitis:
  • Osteomyelitis secondary to vascular insufficiency:
  • Diabetes[2]
  • Diabetic patients with soft-tissue inflammation or skin ulcers in the feet

Common symptoms

  • Local:

Special Considerations

  • Diabetic patients with osteomyelitis secondary to vascular insufficiency typically do not have fever or inflammation.[5]
  • Diabetic patients with advanced neuropathy may not feel pain.
  • Fever is typically absent in patients with infected prosthesis.
  • Patients with vertebral osteomyelitis may have generalized neck and back pain.
  • The presence of a draining sinus tract is pathognomonic of chronic osteomyelitis.

References

  1. ↑ Lew, Daniel P.; Waldvogel, Francis A. (1997). "Osteomyelitis". New England Journal of Medicine. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. ISSN 0028-4793.
  2. ↑ Caputo, Gregory M.; Cavanagh, Peter R.; Ulbrecht, Jan S.; Gibbons, Gary W.; Karchmer, Adolf W. (1994). "Assessment and Management of Foot Disease in Patients with Diabetes". New England Journal of Medicine. 331 (13): 854–860. doi:10.1056/NEJM199409293311307. ISSN 0028-4793.
  3. ↑ Lew, Daniel P; Waldvogel, Francis A (2004). "Osteomyelitis". The Lancet. 364 (9431): 369–379. doi:10.1016/S0140-6736(04)16727-5. ISSN 0140-6736.
  4. ↑ Vazquez M (2002). "Osteomyelitis in children". Curr. Opin. Pediatr. 14 (1): 112–5. PMID 11880745.
  5. ↑ Newman LG, Waller J, Palestro CJ, Schwartz M, Klein MJ, Hermann G, Harrington E, Harrington M, Roman SH, Stagnaro-Green A (1991). "Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline". JAMA. 266 (9): 1246–51. PMID 1908030.
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