Osteomyelitis Questions & Answers

Updated: Jul 13, 2020
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Questions & Answers

Overview

What is osteomyelitis?

How is treatment of osteomyelitis approached?

What is the anatomy of the bony skeleton relevant to osteomyelitis?

Which anatomical structures are commonly infected in osteomyelitis?

What is the pathophysiology of osteomyelitis?

What are factors affecting the pathogenesis of osteomyelitis?

What is the most common site of hematogenous osteomyelitis?

What are primary and secondary hematogenous osteomyelitis?

What is the most common pathogenic organism recovered in osteomyelitis?

What is the initiating factor in the pathophysiology of contiguous-focus osteomyelitis?

What is posttraumatic osteomyelitis?

What is the role of septic arthritis in the pathogenesis of posttraumatic osteomyelitis?

What is the most common cause of infection in osteomyelitis?

Which physical findings are characteristic of contiguous-focus and posttraumatic osteomyelitis?

Which factors increase the risk for vertebral osteomyelitis?

How does the infection of vertebral osteomyelitis originate?

What are the potential sources of infection in vertebral osteomyelitis?

What are the symptoms of vertebral osteomyelitis?

How does acute hematogenous osteomyelitis occur?

What is the prevalence of pathologic fracture in osteomyelitis?

What is the most commonly isolated organism in children with subacute focal osteomyelitis?

What are the common causes of infection in osteomyelitis following puncture wounds or open injuries to bone?

What is the cause of osteomyelitis in the neonate?

What is the association of osteomyelitis with sickle cell?

What are the major causes of osteomyelitis?

What is the prevalence of posttraumatic and postoperative osteomyelitis?

What is the prevalence of hematogenous osteomyelitis?

What is the incidence of spinal osteomyelitis?

What is the prognosis of osteomyelitis?

Presentation

What are the signs and symptoms of osteomyelitis?

What should be the focus of history for the evaluation of chronic posttraumatic osteomyelitis?

Which physical findings are characteristic of osteomyelitis?

What is the clinical presentation of osteomyelitis in children?

What is the most common complication of osteomyelitis in children?

What are the catheter-associated complications of osteomyelitis?

What is the association between dementia and osteomyelitis?

DDX

How is osteomyelitis differentiated from crystal arthropathies?

How is osteomyelitis differentiated from Ewing sarcomas?

How is osteomyelitis differentiated from septic arthritis?

How is osteomyelitis differentiated from a vaso-occlusive crisis in patients with sickle cell disease?

What are the differential diagnoses for Osteomyelitis?

Workup

What is the role of blood cultures in the diagnosis of osteomyelitis?

What is the role of MRI in the workup of osteomyelitis?

What imaging guidelines have been published for the diagnosis of osteomyelitis?

What is the initial imaging study performed in the evaluation of acute osteomyelitis?

Which radiographic findings are characteristic of osteomyelitis?

What is the role of CT scanning in the workup of osteomyelitis?

What are the limitations of CT scanning in the workup of osteomyelitis?

Which findings on MRI are characteristic osteomyelitis?

What is the role of ultrasonography in the workup of osteomyelitis?

What is the role of three-phase bone scanning in the workup of osteomyelitis?

How is nuclear medicine imaging performed in the workup of osteomyelitis?

What is the role of bone biopsy in the workup of osteomyelitis?

How is osteomyelitis diagnosed?

When is a repeat bone biopsy indicated in the workup of osteomyelitis?

Which histologic findings suggest acute osteomyelitis?

Which histologic findings suggest chronic osteomyelitis?

Which histologic findings of osteomyelitis indicate inflammatory reaction and atrophy disuse?

What system is used to classify osteomyelitis?

What is the first part of the Cierny-Mader classification of osteomyelitis?

What is the second part of the Cierny-Mader classification of osteomyelitis?

What is the Gordon classification system of osteomyelitis?

What is the Ger classification of osteomyelitis?

How is osteomyelitis prevented with wound management?

What is the Weiland classification of osteomyelitis?

What is the Kelly classification of osteomyelitis?

Treatment

When is surgery indicated for the treatment of osteomyelitis?

What are the indications for surgery in the treatment of vertebral osteomyelitis?

Which organization has published guidelines for the diagnosis and treatment of vertebral osteomyelitis?

What is the role of antibiotics in the treatment of osteomyelitis?

What is the role of prophylactic antibiotics in the management of osteomyelitis?

What is the role of gentamicin-impregnated Septopal beads in the treatment of osteomyelitis?

What is the duration of antibiotic therapy for osteomyelitis?

Which oral antibiotics are effective in treating osteomyelitis?

What is the role of oral quinolones in the treatment of osteomyelitis?

What is the role of empiric therapy in the treatment of osteomyelitis?

Which bacteria causing osteomyelitis are antibiotic resistant?

What is the role of suppressive antibiotic therapy in the treatment of osteomyelitis?

What does "dead space" refer to in surgery for osteomyelitis?

How is the Cierny-Mader classification system used to guide surgery for osteomyelitis?

What are the surgical options for osteomyelitis?

How is osteomyelitis treated when a fracture and stable hardware are involved?

What is the role of debridement in the treatment of osteomyelitis?

What is the role of CT scanning in surgery for osteomyelitis?

How are fractures managed in osteomyelitis?

What preoperative planning is performed for the Ilizarov method to surgically treat osteomyelitis?

What is the Ilizarov method for treatment of osteomyelitis?

What are the benefits of the Ilizarov technique to treat osteomyelitis?

What is the Ilizarov external fixator for treatment of osteomyelitis?

What is tension stress and how is it employed in the treatment of osteomyelitis?

What is the role of gentle distraction in the Ilizarov method of osteomyelitis treatment?

What are the disadvantages of the Ilizarov method for treatment of osteomyelitis?

What is the role of muscle flaps in the treatment of osteomyelitis?

What is the role of adjunctive hyperbaric oxygen therapy in the treatment of osteomyelitis?

What are possible complications of the Ilizarov technique to treat osteomyelitis?

How can the complications rate of the Ilizarov technique be reduced in osteomyelitis?

What in included in postoperative treatment of osteomyelitis?

During postoperative monitoring of osteomyelitis, what complication may occur?

When are imaging studies indicated for postoperative monitoring osteomyelitis?

Guidelines

What guidelines have been issued for the diagnosis of osteomyelitis?

What is the recommended initial imaging study in suspected osteomyelitis?

What are the recommended imaging studies for diagnosis of osteomyelitis with soft tissue swelling or infection?

What are the recommended imaging studies for diagnosis of osteomyelitis associated with nonarthroplasty hardware?

What are the recommended imaging studies for diagnosis of osteomyelitis in draining sinus (not associated with a joint prosthesis)?

What are the initial imaging studies for evaluation of crepitus and suspected soft-tissue gas in osteomyelitis?

What are the recommended imaging studies for diagnosis of osteomyelitis following initial radiographs showing soft-tissue gas in the absence of a puncture wound?

How are the IDSA clinical guidelines for native vertebral osteomyelitis (NVO) structured?

When should the diagnosis of native vertebral osteomyelitis (NVO) be considered?

What are the IDSA guidelines for the workup of suspected native vertebral osteomyelitis (NVO)?

What are the IDSA guidelines for image-guided aspiration biopsy in the evaluation of osteomyelitis?

How long should antimicrobial therapy be withheld before image-guided diagnostic aspiration biopsy in suspected native vertebral osteomyelitis (NVO)?

When are fungal/mycobacterial/brucellar cultures or other specialized testing indicated in the evaluation of suspected native vertebral osteomyelitis (NVO)?

When is pathologic exam of specimens indicated in the diagnosis of suspected native vertebral osteomyelitis (NVO)?

According to IDSA guidelines, what steps are taken following nondiagnostic image-guided aspiration biopsy in the evaluation of native vertebral osteomyelitis (NVO)?

What are the IDSA guidelines for initiation of empiric antimicrobial therapy for osteomyelitis?

What is the optimal duration of antimicrobial therapy for osteomyelitis?

What are the indications for surgical intervention for osteomyelitis?

How is failure of therapy defined in osteomyelitis?

What is the role of systemic inflammatory markers and MRI in the long-term monitoring of osteomyelitis?

What actions are needed in suspected treatment failure of osteomyelitis?