Osteomyelitis Clinical Presentation

Updated: Mar 01, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Presentation

History

Osteomyelitis is often diagnosed clinically with nonspecific symptoms such as fever, chills, fatigue, lethargy, or irritability. The classic signs of inflammation, including local pain, swelling, or redness, may also occur and usually disappear within 5-7 days. [1]

Chronic posttraumatic osteomyelitis requires a detailed history for diagnosis, including information regarding the initial injury and previous antibiotic and surgical treatment. Weightbearing and function of the involved extremity are typically disturbed. Local pain, swelling, erythema, and edema may also be reported. [2]

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Physical Examination

On physical examination, scars or local disturbance of wound healing may be noted along with the cardinal signs of inflammation. [2] Range of motion, deformity, and local signs of impaired vascularity are also sought in the involved extremity. If periosteal tissues are involved, point tenderness may be present. [5]

In children, the clinical presentation of osteomyelitis can be challenging for physicians because it can present with only nonspecific signs and symptoms and because the clinical findings are extremely variable. Children may present with decreased movement and pain in the affected limb and adjacent joint, as well as edema and erythema over the involved area. In addition, children may also present with fever, malaise, and irritability. Newborns with osteomyelitis may demonstrate decreased movement of a limb without any other signs or symptoms.

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Complications

The most common complication in children with osteomyelitis is recurrence of bone infection. Although adverse outcomes are common with delays in treatment, chronic infection may still develop in 5-10% of patients treated appropriately. Common complications in children younger than 18 months include bone destruction, chronic osteomyelitis, and impaired bone growth, especially when the growth plate is affected. Although rare, extreme bone destruction or thinning of the cortex can lead to pathologic fractures.

When centrally placed intravenous catheters are used in cases that require prolonged antibiotic treatment intravenously, catheter-associated complications can occur. However, the use of peripherally inserted central venous catheters has decreased this complication.

In a study of 17,238 Taiwanese patients newly diagnosed with chronic osteomyelitis from 2000 to 2008 who were identified on the basis of Taiwanese National Health Insurance (NHI) inpatient claims, Tseng et al found chronic osteomyelitis to be associated with an increased risk of dementia, particularly among the younger patients studied. [15]

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