Osteomyelitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A., Seyedmahdi Pahlavani, M.D. [2]
Overview
Symptoms begin several days to weeks after infection. Symptoms lasting approximately less than 14 days is considered acute osteomyelitis, while longer lasting symptoms constitute chronic osteomyelitis. Acute symptoms include a prodrome accompanied by local erythema, edema, warmth, and pain.
Patients with chronic osteomyelitis develop sinus tracts or sequestra. Bearing weight may become increasingly difficult and patients may develop soft tissue ulcers, nonhealing fractures, and Brodie's abscess. Complications include bone destruction, amputation, contiguous infection of joints or soft tissue, impaired bone growth in children, neoplasm, or tumor. Prognosis is generally good for acute osteomyelitis but usually poor for patients with chronic osteomyelitis.
Natural History
- Acute infection is typically defined as symptoms lasting less than 14 days and if left untreated it may lead to chronic osteomyelitis.[1]
- Patients typically develop prodromal symptoms after several days such as fever, malaise, irritability, lethargy, and chills.
- Local symptoms soon follow the prodrome and include erythema, edema, warmth, and pain.
- Chronic osteomyelitis is defined as the presence or recurrence of symptoms for greater than 4 weeks.
- Patients with chronic osteomyelitis may develop sequestra.
- Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult.
- Patients may develop soft tissue ulcers, nonhealing fractures, and Brodie's abscess.[2]
Complications
The following complications can occur:[3][4]
- Sepsis
- Bone destruction
- Pathologic fractures
- Limb amputation
- Depending on the location of osteomyelitis, local extension of an invasive, suppurative process can lead to septic arthritis, brain abscess, meningitis, spinal cord compression, pneumonia, and empyema.
- Impaired bone growth in children
- Sinus tract formation may be associated with neoplasms, especially in the setting of longstanding infection.[5][6][7]
- Most common: squamous cell carcinoma
- Less common: fibrosarcoma, myeloma, lymphoma, plasmacytoma, angiosarcoma, rhabdomyosarcoma, and malignant fibrous histiocytoma
Prognosis
- With treatment, the outcome for acute osteomyelitis is usually good.[8]
- Prognosis is usually poor for patients with chronic osteomyelitis, even with surgery.
- Amputation may be needed, especially in those with diabetes or poor blood circulation.
- Patients with chronic osteomyelitis may have recurring symptoms after treatment.
- The outlook for those with an infection of an orthopedic prosthesis depends on:
- The patient's immunity status
- The type of infection
- Whether the infected prosthesis can be safely removed
References
- ↑ Riise, Oystein R; Kirkhus, Eva; Handeland, KaiS; Flato, Berit; Reiseter, Tor; Cvancarova, Milada; Nakstad, Britt; Wathne, Karl-Olaf (2008). "Childhood osteomyelitis-Incidence and differentiation from other acute onset musculoskeletal features in a population-based study". BMC Pediatrics. 8 (1): 45. doi:10.1186/1471-2431-8-45. ISSN 1471-2431.
- ↑ Lew, Daniel P; Waldvogel, Francis A (2004). "Osteomyelitis". The Lancet. 364 (9431): 369–379. doi:10.1016/S0140-6736(04)16727-5. ISSN 0140-6736.
- ↑ Gelfand MS, Cleveland KO, Heck RK, Goswami R (2006). "Pathological fracture in acute osteomyelitis of long bones secondary to community-acquired methicillin-resistant Staphylococcus aureus: two cases and review of the literature". Am. J. Med. Sci. 332 (6): 357–60. PMID 17170628.
- ↑ Johnston RM, Miles JS (1973). "Sarcomas arising from chronic osteomyelitic sinuses. A report of two cases". J Bone Joint Surg Am. 55 (1): 162–8. PMID 4691654.
- ↑ Altay M, Arikan M, Yildiz Y, Saglik Y (2004). "Squamous cell carcinoma arising in chronic osteomyelitis in foot and ankle". Foot Ankle Int. 25 (11): 805–9. PMID 15574240.
- ↑ Czerwiński E, Skolarczyk A, Frasik W (1991). "Malignant fibrous histiocytoma in the course of chronic osteomyelitis". Arch Orthop Trauma Surg. 111 (1): 58–60. PMID 1663383.
- ↑ McGrory JE, Pritchard DJ, Unni KK, Ilstrup D, Rowland CM (1999). "Malignant lesions arising in chronic osteomyelitis". Clin. Orthop. Relat. Res. (362): 181–9. PMID 10335297.
- ↑ Osteomyelitis. MedlinePlus (May 01, 2015). https://www.nlm.nih.gov/medlineplus/ency/article/000437.htm Accessed April 15, 2016.