Types
Defining Characteristics
Increasing pain, skull/mandible/ small bones hand/ long bones/feet, mild fever, minimal drainage
Diabetic osteomyelitis? Painless (due to peripheral neuropathy in most DM pts) ulcer extending to bone, mild cellulitis, crepitance [If it probes to the bone, it’s osteomyelitis]
Disease Development
Bacterial infection from localized ulceration/ trauma travel further to the bone
Potential Causes
Possible polymicrobial (see diabetic foot ulcer bacteria)
Mixed gram+/-, anaerobes
Epidemiology
MOST common in adults
Risk factors
Chronic skin ulcers (arterial sclerotic dz), trauma, diabetes, post-op ortho surgery, chronic edema
Lab/Imaging
Imaging hard to interpret bc surrounding soft tissue inf
Bone scan sometimes reveals contiguous spread from ulcer site
Bone sample for culture
Conventional Treatment
Revascularization
Amputation/ surgical debridement
Abs for 4-8wks (Avoid empiric ab tx)