Evaluation of osteomyelitis in diabetic foot ulcers with exposed bone

Abstract

Purpose Exposed bone and periosteal damage promote the adherence of pathogens to bone matrix components. Damage to the periosteum adversely affects bone perfusion and creates a more suitable environment for pathogens. The purpose of this study was to determine the prevalence of osteomyelitis among patients with diabetic foot ulcers with bone exposure and to identify the role of simple serological markers in the diagnosis of osteomyelitis in this patient group.Methods Patients who underwent amputation and debridement due to diabetes-related foot wound were included in the study. The pathology results were evaluated according to presence of osteomyelitis. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), complete blood count (CBC), platelet/lymphocyte ratio, neutrophil/lymphocyte ratio (NLR) and microbial growth were analysed.Results Patients with ESR of 79mm/h or lower had a 3.046-fold higher risk of osteomyelitis. The risk of osteomyelitis was 2.901-fold higher at lymphocyte percentages of 12.3% or higher. Patients with a neutrophil percentage of 78% or lower had a 3.010-fold higher risk of osteomyelitis. Patients with NLR of 6.02 or lower had a 2.901-fold risk of osteomyelitis. When ESR was evaluated with neutrophil percentage, lymphocyte percentage and NLR, the sensitivity was calculated as 86.76% for osteomyelitis. ConclusionWe believe that the immune response caused by bone exposure to the environment is different than the immune response caused by soft tissue infection in the classical diabetic foot. The combined evaluation of multiple diagnostic parameters increases the sensitivity of osteomyelitis diagnosis.