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Osteomyelitis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Osteomyelitis (OM): Infection of bone with ongoing inflammatory destruction

  • Usually bacterial, but fungal OM does occur

  • Could be acute or chronic

Etiology

  • Hematogenous OM:

    • Primarily in ch...

Diagnosis

Signs and Symptoms

Vary with duration of disease 

History

  • Mainly nonspecific symptoms

  • Pain: Localized, deep, dull, and throbbing; occurs with and without movement

  • Fever and chills; may be absent ...

Treatment

Initial Stabilization/Therapy

Emergent stabilization if septic or if neurologic deficits from spine involvement 

Ed Treatment/Procedures

  • Empiric antibiotic treatment in ED

  • Cultures should guide ...

Follow-Up

Disposition

Admission Criteria

  • Patients with acute OM should be admitted.

  • Patients with chronic OM usually require admission for surgical procedures, débridement, and obtaining bone cultures an...

Pearls and Pitfalls

  • WBC may be normal in many cases.

  • Radiographs may be normal in the 1st 2–3 wk of symptoms.

  • Wound cultures are low yield in guiding antibiotic therapy.

Additional Reading

  • Butalia  S, Palda  VA, Sargeant  RJ, et al. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA.  2008;299(7):806–813.

  • Hatzenbuehler  J, Pulling  TJ....

Codes

ICD9

  • 730.00 Acute osteomyelitis, site unspecified

  • 730.10 Chronic osteomyelitis, site unspecified

  • 730.20 Unspecified osteomyelitis, site unspecified

  • 730.28 Unspecified osteomyelitis, other specified ...

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