Osteomyelitis may be classified according to the symptom chronology into acute, sub-acute (further subdivided into the Glendhill and Robert et al. systems), and chronic.
Stage 4 pressure ulcers, the most severe, involve full-thickness tissue loss, with exposed bone, tendon, or muscle [6].
If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis).
Chronic osteomyelitis, as a clinical entity, encompasses a wide array of clinical scenarios, including chronic haematogenous osteomyelitis, post-traumatic osteomyelitis, periprosthetic infections and contiguous osteomyelitis.
Stage 3, or localized, osteomyelitis usually involves both cortical and medullary bone. In this stage, the bone remains stable, and the infectious process does not involve the entire bone diameter.
The symptoms of osteomyelitis include: Localised bone pain. Reduced movement of the affected body part. The overlying skin may be red, hot and swollen.
Outlook (Prognosis)
With treatment, the outcome for acute osteomyelitis is often good. The outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially in people with diabetes or poor blood circulation.
Blood cultures should always be obtained when osteomyelitis is suspected, though they are often negative except in cases of hematogenous osteomyelitis. The gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathologic examination and tissue culture.
Acute osteomyelitis typically refers to an infection of less than 1 month's duration, whereas chronic osteomyelitis refers to infection that lasts longer than 4 weeks.
Long-term Considerations for Osteomyelitis
Fractures of the affected bone. Stunted growth in children (if the infection has involved the growth plate) Gangrene infection in the affected area.
The infection spreads to the bone after several days or weeks. This type of spread is particularly likely to occur in older people. Such an infection may start in an area damaged by an injury or surgery, radiation therapy, or cancer or in a skin ulcer (particularly a foot ulcer) caused by poor circulation or diabetes.
Although once considered incurable, osteomyelitis can now be successfully treated. Most people need surgery to remove areas of the bone that have died. After surgery, strong intravenous antibiotics are typically needed.
Acute osteomyelitis typically presents two weeks after bone infection, characterised by inflammatory bone changes. By contrast, chronic osteomyelitis typically presents six or more weeks after bone infection and is characterised by the presence of bone destruction and formation of sequestra.
Although osteomyelitis is a difficult problem, certain conditions make it even more difficult to address. Diabetes, peripheral vascular disease, and radiation are all comorbidities that interfere with wound healing and therefore make the treatment of osteomyelitis challenging.
In adults, the vertebrae are the most common site of hematogenous osteomyelitis, but infection may also occur in the long bones, pelvis, and clavicle. Primary hematogenous osteomyelitis is more common in infants and children, usually occurring in the long-bone metaphysis.
7, 8 The prevalence of malignant transformation in the setting of chronic osteomyelitis ranges from 1.6% to 23%, and the most commonly affected bones are the tibia and femur. The most frequently observed malignant transformation is squamous cell carcinoma of the skin.
The most common complication in children with osteomyelitis is recurrence of bone infection.
For chronic osteomyelitis, parenteral antibiotic therapy for two to six weeks is generally recommended, with a transition to oral antibiotics for a total treatment period of four to eight weeks.
The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.
Results. Patients with chronic osteomyelitis had a significantly higher mortality risk than those without chronic osteomyelitis [incidence rate ratio (IRR): 2.29; 95 % confidence interval (CI): 2.01–2.59], particularly the old elderly (≥85 years; IRR: 3.27; 95 % CI: 2.22–4.82) and males (IRR: 2.7; 95 % CI: 2.31–3.16).
Open upper extremity fractures with severe soft-tissue damage have the highest risk of developing osteomyelitis.
Early findings may be subtle, and changes may not be obvious until 5 to 7 days in children and 10 to 14 days in adults. Typical early bony changes include: periosteal thickening, lytic lesions, endosteal scalloping, osteopenia, loss of trabecular architecture, and new bone apposition.
Acute osteomyelitis develops rapidly over a period of seven to 10 days.