Osteomyelitis natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
*Acute osteomyelitis presents with symptom onset after several days to weeks. | *Acute osteomyelitis presents with symptom onset after several days to weeks.<ref name="RiiseKirkhus2008">{{cite journal|last1=Riise|first1=Oystein R|last2=Kirkhus|first2=Eva|last3=Handeland|first3=Kai S|last4=Flato|first4=Berit|last5=Reiseter|first5=Tor|last6=Cvancarova|first6=Milada|last7=Nakstad|first7=Britt|last8=Wathne|first8=Karl-Olaf|title=Childhood osteomyelitis-Incidence and differentiation from other acute onset musculoskeletal features in a population-based study|journal=BMC Pediatrics|volume=8|issue=1|year=2008|pages=45|issn=1471-2431|doi=10.1186/1471-2431-8-45}}</ref> | ||
:*Acute infection is typically defined as symptoms lasting less than 14 days. | :*Acute infection is typically defined as symptoms lasting less than 14 days. | ||
:*Patients typically develop [[prodromal symptoms]] after several days including: fever, malaise, irritability, lethargy, and chills. | :*Patients typically develop [[prodromal symptoms]] after several days including: fever, malaise, irritability, lethargy, and chills. | ||
| Line 13: | Line 13: | ||
:*Patients with chronic osteomyelitis develop sequestra. | :*Patients with chronic osteomyelitis develop sequestra. | ||
:*Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult. | :*Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult. | ||
:*Patients may develop soft tissue [[Ulcer|ulcers]], nonhealing [[Fracture|fractures]], and [[Brodie's abscess]]. | :*Patients may develop soft tissue [[Ulcer|ulcers]], nonhealing [[Fracture|fractures]], and [[Brodie's abscess]].<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> | ||
==Complications== | ==Complications== | ||
Chronic osteomyelitis may cause the following complications: | Chronic osteomyelitis may cause the following complications: | ||
*Bone destruction | *Bone destruction | ||
*Pathologic [[fractures]] | *Pathologic [[fractures]]<ref name="pmid17170628">{{cite journal| author=Gelfand MS, Cleveland KO, Heck RK, Goswami R| title=Pathological fracture in acute osteomyelitis of long bones secondary to community-acquired methicillin-resistant Staphylococcus aureus: two cases and review of the literature. | journal=Am J Med Sci | year= 2006 | volume= 332 | issue= 6 | pages= 357-60 | pmid=17170628 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17170628 }} </ref> | ||
*Limb [[amputation]] | *Limb [[amputation]] | ||
*Contiguous infection of joints or soft tissue | *Contiguous infection of joints or soft tissue | ||
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==Prognosis== | ==Prognosis== | ||
*With treatment, the outcome for acute osteomyelitis is usually good. | *With treatment, the outcome for acute osteomyelitis is usually good.<ref>Osteomyelitis. MedlinePlus (May 01, 2015). https://www.nlm.nih.gov/medlineplus/ency/article/000437.htm Accessed April 15, 2016.</ref> | ||
*Prognosis is usually poor for patients with chronic osteomyelitis, even with surgery. | *Prognosis is usually poor for patients with chronic osteomyelitis, even with surgery. | ||
:*[[Amputation]] may be needed, especially in those with [[diabetes]] or poor blood circulation. | :*[[Amputation]] may be needed, especially in those with [[diabetes]] or poor blood circulation. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nate Michalak, B.A.
Overview
Natural History
- Acute osteomyelitis presents with symptom onset after several days to weeks.[1]
- Acute infection is typically defined as symptoms lasting less than 14 days.
- Patients typically develop prodromal symptoms after several days including: fever, malaise, irritability, lethargy, and chills.
- Local symptoms soon follow the prodrome and include: erythema, edema, warmth, and pain.
- Chronic osteomyelitis is defined as presence or recurrence of symptoms for greater than 14 days.
- Patients with chronic osteomyelitis develop sequestra.
- Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult.
- Patients may develop soft tissue ulcers, nonhealing fractures, and Brodie's abscess.[2]
Complications
Chronic osteomyelitis may cause the following complications:
- Bone destruction
- Pathologic fractures[3]
- Limb amputation
- Contiguous infection of joints or soft tissue
- Reduced limb or joint function
- Impaired bone growth in children
- Neoplasm
- Tumor[4]
- Most common: squamous cell carcinoma
- Less common: fibrosarcoma, myeloma, lymphoma, plasmacytoma, angiosarcoma, rhabdomyosarcoma, and malignant fibrous histiocytoma
Prognosis
- With treatment, the outcome for acute osteomyelitis is usually good.[5]
- Prognosis is usually poor for patients with chronic osteomyelitis, even with surgery.
- Amputation may be needed, especially in those with diabetes or poor blood circulation.
- The outlook for those with an infection of an orthopedic prosthesis depends, in part, on:
- The patient's health
- The type of infection
- Whether the infected prosthesis can be safely removed
References
- ↑ Riise, Oystein R; Kirkhus, Eva; Handeland, Kai S; Flato, Berit; Reiseter, Tor; Cvancarova, Milada; Nakstad, Britt; Wathne, Karl-Olaf (2008). "Childhood osteomyelitis-Incidence and differentiation from other acute onset musculoskeletal features in a population-based study". BMC Pediatrics. 8 (1): 45. doi:10.1186/1471-2431-8-45. ISSN 1471-2431.
- ↑ 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.
- ↑ Gelfand MS, Cleveland KO, Heck RK, Goswami R (2006). "Pathological fracture in acute osteomyelitis of long bones secondary to community-acquired methicillin-resistant Staphylococcus aureus: two cases and review of the literature". Am J Med Sci. 332 (6): 357–60. PMID 17170628.
- ↑ Johnston RM, Miles JS (1973). "Sarcomas arising from chronic osteomyelitic sinuses. A report of two cases". J Bone Joint Surg Am. 55 (1): 162–8. PMID 4691654.
- ↑ Osteomyelitis. MedlinePlus (May 01, 2015). https://www.nlm.nih.gov/medlineplus/ency/article/000437.htm Accessed April 15, 2016.