Osteomyelitis: Diagnosis and Treatment
- Bury, David C. DO, MPH
- Rogers, Tyler S. MD
- Dickman, Michael M. DO, MBA
1Martin Army Community Hospital, Fort Benning, Georgia; Uniformed Services University of the Health Sciences, Bethesda, Maryland
2Madigan Army Medical Center, Joint Base Lewis-McChord, Washington; Uniformed Services University of the Health Sciences, Bethesda, Maryland; University of Washington School of Medicine, Seattle, Washington
The Authors
DAVID C. BURY, DO, MPH, FAAFP, is program director of the Family Medicine Residency Program at Martin Army Community Hospital, Fort Benning, Ga., and is assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md. At the time this article was written, Dr. Bury was a fellow in the Leadership and Faculty Development Fellowship Program at Madigan Army Medical Center, Joint Base Lewis-McChord, Wash.
TYLER S. ROGERS, MD, FAAFP, is a fellow in the Leadership and Faculty Development Fellowship Program at Madigan Army Medical Center, an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, and a clinical assistant professor in the Department of Family Medicine at the University of Washington School of Medicine, Seattle.
MICHAEL M. DICKMAN, DO, MBA, FAAFP, is Chief of the Department of Soldier and Community Health at Madigan Army Medical Center, an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, and a clinical assistant professor in the Department of Family Medicine at the University of Washington School of Medicine. At the time this article was written, Dr. Dickman was a fellow in the Leadership and Faculty Development Fellowship Program at Madigan Army Medical Center.
Address correspondence to David C. Bury, DO, MPH, FAAFP, 6600 Van Aalst Blvd., Fort Benning, GA 31905 (email:[email protected]). Reprints are not available from the authors.
Author disclosure: No relevant financial affiliations.
Patient information: See related handout on osteomyelitis, written by the authors of this article.
This clinical content conforms to AAFP criteria for CME. See the CME Quiz Questions.
This article updates a previous article on this topic by Hatzenbuehler, et al.
Data Sources: A PubMed search was completed in Clinical Queries using the key terms osteomyelitis, imaging, diagnosis, and treatment. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Also searched were the Cochrane database, the Database of Abstracts of Reviews of Effectiveness (DARE), Dynamed, and Essential Evidence Plus. Search dates: August 11, 2020, and March 10, 2021.
Figure 2, Figure 3, and Figure 4 provided by Timothy G. Russell, MD, Department of Radiology, Martin Army Community Hospital.
FIGURE 2.
Anteroposterior foot radiograph demonstrating focal osteopenia and cortical disruption of the third distal phalanx with surrounding periosteal reaction(short thick arrow), consistent with osteomyelitis. The first digit has been amputated at the level of the proximal phalanx diaphysis(long thin arrow)from prior osteomyelitis.
Copyright © Timothy G. Russell, MD
FIGURE 3.
Lateral foot radiograph demonstrating focal osteopenia and cortical disruption of the third distal phalanx with surrounding periosteal reaction(short thick arrow), consistent with osteomyelitis. A subtle lucency involving the soft tissues of the third distal phalanx tip(long thin arrow)is consistent with a superficial ulcer that was noted on physical examination.
Copyright © Timothy G. Russell, MD
FIGURE 4.
Axial T1-weighted (T1W) foot magnetic resonance imaging scan demonstrating confluent low T1 signal (compared to normal bone marrow) throughout the third distal phalanx marrow(short thick arrow), consistent with osteomyelitis. There is also some involvement of the head of the third middle phalanx(long thin arrow). The first digit has been amputated at the level of the proximal phalanx diaphysis(long thick arrow)from prior osteomyelitis.
Copyright © Timothy G. Russell, MD
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department or the U.S. Army at large.
Osteomyelitis is an inflammatory condition of bone secondary to an infectious process. Osteomyelitis is usually clinically diagnosed with support from imaging and laboratory findings. Bone biopsy and microbial cultures offer definitive diagnosis. Plain film radiography should be performed as initial imaging, but sensitivity is low in the early stages of disease. Magnetic resonance imaging with and without contrast media has a higher sensitivity for identifying areas of bone necrosis in later stages. Staging based on major and minor risk factors can help stratify patients for surgical treatment. Antibiotics are the primary treatment option and should be tailored based on culture results and individual patient factors. Surgical bony debridement is often needed, and further surgical intervention may be warranted in high-risk patients or those with extensive disease. Diabetes mellitus and cardiovascular disease increase the overall risk of acute and chronic osteomyelitis. (Am Fam Physician. 2021;104(4):395-402. Copyright © 2021 American Academy of Family Physicians.)