Osteomyelitis in adults almost always presents in a patient with diabetes, peripheral arterial disease, or both with an ulcer or soft tissue infection. You can also think about osteomyelitis in patients with direct trauma and a history of orthopedic surgery , but the case with diabetes and peripheral vascular disease is more likely to show up on exam.
Diagnostic Testing:
- Best initial test : Plain X ray
- Best second test ( if X ray is negative and there is clinical suspicion) : MRI
- Most accurate test: bone biopsy and culture
The patient losses almost 50 % of the bone calcium before the x ray becomes abnormal. Although it may take up to 2 weeks for osteomyelitis to become severe enough to show on X ray , the X ray is still the best test.
Question:
Which of the following is the earliest finding of osteomyelitis on X ray?
A. Periosteal elevation
B. Involucrum
C. Sequestrum
D. Punched out lesions
E. Fracture
Answer: A (Perisoteal elevation)
The earliest finding of osteomyelitis on an x ray s the elevation of periosteum.
Involucrum and sequestrum are terms applied to the formation of abnormal new bone in the periosteum and chunks of bone chipped off from the infection.
Punched out lesions are seen in myeloma, not osteomyelitis
Osteomyelitis does not have association with fracture.
Question:
A 67 year old man with diabetes comes with the complaint of pain in his leg for 2 weeks. On examination there is an ulcer with a draining sinus tract. . The x ray is normal. What is the best next step in determining the diagnosis:
A. Bone scan
B. CT scan
C. MRI
D. ESR
E. Biopsy
Answer; C (MRI)
The MRI is the best nest test in determining the diagnosis of osteomyelitis if X ray is normal.
A bone scan does not have the specificity of MRI.
ESR helps in following the response to therapy.
Remember that osteomyelitis is most commonly caused by direct contagious spread from overlying tissue, but heamtogenous (blood) infection can also be present as a cause of osteomyelitis so a blood culture especially if the patient looks septic is a good idea but still perform MRI first.
Treatment For Osteomyelitis:
Stapylococcus is the most common organism causing osteomylelitis . If it is sensitive, give oxacillin or naficillin intravenously for 4-6 weeks.
MRSA is treated with vancomycin, linezolid, ceftaroline or daptomycin.
Oral treatment is not effective for staphylococcal osteomylelitis.
Gram negative bacilli like salmonella and pseudomonas are also to be considered and these can be treated with oral antibiotics.
Vitamin A is one of the useful resource which used different kinds of disease herbal remedies it also play a very important role in the Herbal Treatment for Osteomyelitis .
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