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.
- 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.
Complications
Chronic osteomyelitis may cause the following complications:
- Bone destruction
- Pathologic fractures
- Limb amputation
- Contiguous infection of joints or soft tissue
- Reduced limb or joint function
- Impaired bone growth in children
- Neoplasm
- Tumor[1]
- 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.
- 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
- ↑ 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.