Osteomyelitis

Suspect acute osteomyelitis most commonly in an unwell child with a limp, or in an immunocompromised patient.

Suspect chronic osteomyelitis most commonly in adults with a history of open fracture, previous orthopaedic surgery, or a discharging sinus.

Consider native vertebral osteomyelitis in a patient with new back pain and systemic symptoms.

Request plain x-rays to screen for acute and chronic osteomyelitis.

Magnetic resonance imaging and computed tomography may aid diagnosis and treatment decisions.

Ideally, confirm with deep microbiological samples via radiologically guided biopsy or open surgery; surgery is usually only performed for clinical rather than diagnostic purposes. There is limited value in surface or sinus swabs.

Aim to take microbiological samples before giving empirical antibiotics. However, if the patient is septic or otherwise unwell, sampling should not delay the administration of antibiotics.

In chronic osteomyelitis, surgery to remove necrotic bone is the primary treatment. Antibiotics alone cannot achieve a cure.

Osteomyelitis is an inflammatory condition of bone caused by an infecting organism, most commonly Staphylococcus aureus. It usually involves a single bone but may rarely affect multiple sites. It may occur in the peripheral or axial skeleton. Severity can be staged depending on the aetiology of the infection, its pathogenesis, extent of bone involvement, duration, and host factors particular to the individual patient. Broadly, bone infection is either haematogenous or contiguous-focus. Despite these different causes, all forms of acute osteomyelitis may evolve and become chronic, sharing a final common pathophysiology, with compromised soft-tissue surrounding dead, infected, and reactive new bone.

This topic does not cover babies under 3 months of age.