UMEM Educational Pearls

Category: Orthopedics

Title: Osteomyelitis

Keywords: Osteomyelitis (PubMed Search)

Posted: 5/22/2010 by Michael Bond, MD
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  • An acute or chronic inflammatory, infectious process of bone.  Can occur via hematogenous spread or direct innoculation of bone.
  • Can be diagnosed on plain radiographs but bony changes might not be evident for 14-21 days.  By 28 days 90% of patients will demonstrate a bony abnormality.
  • Initially plain radiographs will show periosteal elevation. Later cortical or medullary lucencies are seen.
  • Additional tests to help make the diagnosis include:
    • Three phase bone scan: often not practical for the ED.
    • CT Scan: better in areas with complex anatomy [i.e.:spine, pelvis, ,mid and hind foot]
    • MRI: most effective in early detection and to guide surgical approaches.  Sensitivity is estimated at 90-100%.


King RW, Johnson D: Osteomyelitis. In: eMedicine. WebMd; 2009.