Osteomyelitis natural history, complications and prognosis
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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.