The probe-to-bone (PTB) test is a commonly used clinical test for osteomyelitis (OM), but its utility has been questioned in clinical settings where the prevalence of OM is low. This article aims to systematically review the accuracy of the PTB test to diagnose diabetic foot OM. We searched Ovid Medline and Scopus databases for studies using the keywords "probe to bone," "osteomyelitis," and "diabetic foot" from 1946 to May 2015. We summarized characteristics of the included studies and pooled the accuracy numbers using a bivariate random-effects model. Seven studies met our inclusion criteria. Pooled sensitivity and specificity for the PTB test was 0.87 (95% confidence interval [CI], .75-.93) and 0.83 (95% CI, .65-.93), respectively. We conclude that the PTB test can accurately rule in diabetic foot OM in the high-risk patients and rule out OM in low-risk patients.

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Preliminary data suggest that an elevated HbA level is not a contraindication to application of a skin graft. The benefits of early wound closure outweigh the risks of skin graft application in patients with diabetes.

Family members perceived that the social consequences of untreated hypospadias would be severe. Relative to patient cohorts reported in practices of high income countries, our patients were older, presented with more severe defects, required more reoperations and were often undernourished. Urethrocutaneous fistula rates were higher in cohorts from low or middle income countries relative to published rates for cohorts from high income countries. Our study suggests that outcomes measurement is a feasible and essential component of ethical international health care delivery and improvement.

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