Osteomyelitis natural history, complications and prognosis: Difference between revisions

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Revision as of 15:23, 3 January 2017

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

Symptoms begin several days to weeks after infection. Symptoms lasting approximately less than 14 days is considered acute osteomyelitis, while longer lasting symptoms constitute chronic osteomyelitis. Acute symptoms include a prodrome accompanied by local erythema, edema, warmth, and pain. Patients with chronic osteomyelitis develop sinus tracts or sequestra. Bearing weight may become increasingly difficult and patients may develop soft tissue ulcers, nonhealing fractures, and Brodie's abscess. Complications include: bone destruction, amputation, contiguous infection of joints or soft tissue, impaired bone growth in children, neoplasm, or tumor. Prognosis is generally good for acute osteomyelitis but usually poor for patients with chronic osteomyelitis.

Natural History

Acute infection is typically defined as symptoms lasting less than 14 days and if left untreated it may lead to chronic osteomyelitis.^[1]

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 4 weeks.

Patients with chronic osteomyelitis may 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

In addition to chronic osteomyelitis, it may cause the following complications:^[3]^[4]^[3]

Sepsis
Bone destruction
Pathologic fractures
Limb amputation
Depending on the location of osteomyelitis, local extension of an invasive, suppurative process can lead to septic arthritis, brain abscess, meningitis, spinal cord compression, pneumonia, and empyema
Impaired bone growth in children
Neoplasm

Sinus tract formation may be associated with neoplasms, especially in the setting of longstanding infection^[5]^[6]^[7]

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.^[8]
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.
Patients with chronic osteomyelitis may have recurring symptoms after treatment.

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, KaiS; 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.
↑ ^3.0 ^3.1 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.
↑ Altay M, Arikan M, Yildiz Y, Saglik Y (2004). "Squamous cell carcinoma arising in chronic osteomyelitis in foot and ankle". Foot Ankle Int. 25 (11): 805–9. PMID 15574240.
↑ Czerwiński E, Skolarczyk A, Frasik W (1991). "Malignant fibrous histiocytoma in the course of chronic osteomyelitis". Arch Orthop Trauma Surg. 111 (1): 58–60. PMID 1663383.
↑ McGrory JE, Pritchard DJ, Unni KK, Ilstrup D, Rowland CM (1999). "Malignant lesions arising in chronic osteomyelitis". Clin. Orthop. Relat. Res. (362): 181–9. PMID 10335297.
↑ Osteomyelitis. MedlinePlus (May 01, 2015). https://www.nlm.nih.gov/medlineplus/ency/article/000437.htm Accessed April 15, 2016.

Template:WH Template:WS

[RiiseKirkhus2008-1] Riise, Oystein R; Kirkhus, Eva; Handeland, KaiS; 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.

[LewWaldvogel2004-2] 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.

[pmid17170628-3] 3.0 ^3.1 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.

[pmid4691654-4] 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.

[pmid15574240-5] Altay M, Arikan M, Yildiz Y, Saglik Y (2004). "Squamous cell carcinoma arising in chronic osteomyelitis in foot and ankle". Foot Ankle Int. 25 (11): 805–9. PMID 15574240.

[pmid1663383-6] Czerwiński E, Skolarczyk A, Frasik W (1991). "Malignant fibrous histiocytoma in the course of chronic osteomyelitis". Arch Orthop Trauma Surg. 111 (1): 58–60. PMID 1663383.

[pmid10335297-7] McGrory JE, Pritchard DJ, Unni KK, Ilstrup D, Rowland CM (1999). "Malignant lesions arising in chronic osteomyelitis". Clin. Orthop. Relat. Res. (362): 181–9. PMID 10335297.

[8] Osteomyelitis. MedlinePlus (May 01, 2015). https://www.nlm.nih.gov/medlineplus/ency/article/000437.htm Accessed April 15, 2016.

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@@ Line 16: / Line 16: @@
 ==Complications==
+In addition to chronic osteomyelitis, it may cause the following complications:<ref name="pmid17170628">{{cite journal |vauthors=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. |volume=332 |issue=6 |pages=357–60 |year=2006 |pmid=17170628 |doi= |url=}}</ref><ref name="pmid4691654">{{cite journal| author=Johnston RM, Miles JS| title=Sarcomas arising from chronic osteomyelitic sinuses. A report of two cases. | journal=J Bone Joint Surg Am | year= 1973 | volume= 55 | issue= 1 | pages= 162-8 | pmid=4691654 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4691654  }} </ref><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>
-Chronic osteomyelitis may cause the following complications:
+*Sepsis
 *Bone destruction
-*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>
+*Pathologic [[fractures]]
 *Limb [[amputation]]
-*Contiguous infection of joints or soft tissue
+*Depending on the location of osteomyelitis, local extension of an invasive, suppurative process can lead to septic arthritis, brain abscess, meningitis, spinal cord compression, pneumonia, and empyema
-*Reduced limb or joint function
 *Impaired bone growth in children
 *[[Neoplasm]]
-*[[Tumor]]<ref name="pmid4691654">{{cite journal| author=Johnston RM, Miles JS| title=Sarcomas arising from chronic osteomyelitic sinuses. A report of two cases. | journal=J Bone Joint Surg Am | year= 1973 | volume= 55 | issue= 1 | pages= 162-8 | pmid=4691654 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4691654  }} </ref>
+Sinus tract formation may be associated with neoplasms, especially in the setting of longstanding infection<ref name="pmid15574240">{{cite journal |vauthors=Altay M, Arikan M, Yildiz Y, Saglik Y |title=Squamous cell carcinoma arising in chronic osteomyelitis in foot and ankle |journal=Foot Ankle Int |volume=25 |issue=11 |pages=805–9 |year=2004 |pmid=15574240 |doi= |url=}}</ref><ref name="pmid1663383">{{cite journal |vauthors=Czerwiński E, Skolarczyk A, Frasik W |title=Malignant fibrous histiocytoma in the course of chronic osteomyelitis |journal=Arch Orthop Trauma Surg |volume=111 |issue=1 |pages=58–60 |year=1991 |pmid=1663383 |doi= |url=}}</ref><ref name="pmid10335297">{{cite journal |vauthors=McGrory JE, Pritchard DJ, Unni KK, Ilstrup D, Rowland CM |title=Malignant lesions arising in chronic osteomyelitis |journal=Clin. Orthop. Relat. Res. |volume= |issue=362 |pages=181–9 |year=1999 |pmid=10335297 |doi= |url=}}</ref>
 :*Most common: [[squamous cell carcinoma]]
 :*Less common: [[fibrosarcoma]], [[myeloma]], [[lymphoma]], [[plasmacytoma]], [[angiosarcoma]], [[rhabdomyosarcoma]], and [[malignant fibrous histiocytoma]]