Osteomyelitis - Diagnosis and Management Summary
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Description

Osteomyelitis - Diagnosis and Management Summary

Clinical Manifestations

Diagnostic approach

 • Ulcer area > 2 cm - LR 7.2 (1.1-49)

 • +“probe-to-bone” test - LR 6.4 (3.6-11)

 • ESR> 70 mm/h - LR 11 (1.6-79)

 • Abnormal plain X-ray - LR 2.3 (1.6-3.3)

 • MRI c/w osteo - LR 3.8 (2.5-5.8)

 • Normal MRI  - LR 0.14 (0.08-0.26)

Imaging:

 • Obtain plain XR 1st, especially in suspected appendicular osteo (normal early in disease, lytic lesions at 2-6wks)

 • MRI: Sn 90%, Sp 82%(Arch Intern Med 2007;167:125); best in DM or if concern for vertebral osteo

 • CT: if MRI not available; can demonstrate periosteal reaction and cortical and medullary destruction

 • CT & MRI very sens but non-spec; false + if contiguous focus with periosteal reaction, Charcot changes

 • Radionuclide bone scan: very sens, but non-spec (false+ if soft-tissue inflam), option if hardware prevents above

Treatment

 • Antibiotics

 • Surgical Debridement



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