How is osteomyelitis diagnosed

How is osteomyelitis diagnosed?

• Gold standard = bone biopsy for culture and pathology.

• Probe-to-bone = using a blunt metal tool to evaluate diabetic foot ulcers; if a hard gritty surface is noted, this is 87% sensitive and 83% specific for osteomyelitis.

• Plain radiographs = can detect osteomyelitis after ∼2 weeks of symptoms (may miss early osteomyelitis).

• MRI = highest sensitivity with detection within 3 to 5 days of symptom onset.

• CT = more sensitive than plain radiographs, less sensitive than MRI. Useful for evaluating for the presence of sequestra and involucrum.

• Laboratory tests will usually reveal leukocytosis and elevations in ESR/CRP. Blood cultures are positive in ∼50% acute hematogenous osteomyelitis cases.

Pearl: Cultures of sinus tracts are not predictive of the organisms found in bone with the exception of S. aureus.


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