Osteomyelitis of the lower extremity: pathophysiology, imaging, and classification, with an emphasis on diabetic foot infection

Abstract

Osteomyelitis is inflammation of the bone caused by an infectious organism, and is a difficult clinical problem. The pathophysiology, imaging, and classification of osteomyelitis are challenging, varying with the age of the patient (child versus adult), the chronicity of the infection (acute versus chronic), and the route of spread (hematogenous versus contiguous focus), as well as the immune and vascular status of the patient and affected region. The two most common classification schemes are those of Lew and Waldvogel, and Cierny and Mader. Brodie's abscess is seen in subacute osteomyelitis, while sequestrum, involucrum, and cloaca are inter-related entities of chronic osteomyelitis. Imaging workup of suspected osteomyelitis should begin with radiographs, although MRI is the most accurate imaging test. Three patterns of T1 signal change have been described in the setting of suspected osteomyelitis including confluent intramedullary, hazy reticular, and subcortical. The confluent intramedullary pattern is most associated with osteomyelitis, while hazy reticular is rarely associated with hematogenous osteomyelitis, and subcortical is not associated with osteomyelitis. It can be challenging to differentiate neuropathic arthropathy from osteomyelitis. Osteomyelitis tends to involve a single bone subjacent to an ulcer or sinus tract. In contrast, neuropathic arthropathy tends to involve multiple bones of the midfoot. Subchondral cystic change, thin rim enhancement of a joint effusion, and the presence of intra-articular bodies are more indicative of a neuropathic joint without infection. Biopsy can play an important role in diagnosis and treatment of osteomyelitis.

The needle and the damage done: musculoskeletal and vascular complications associated with injected drug use

“…Osteomyelitis is defined as bone inflammation caused by an infectious process and may be acute or chronic [ 17 ]. It is often difficult to diagnose in the acute setting and can rapidly progress to a destructive process leading to significant long-term disability and pain.…”

“…It is often difficult to diagnose in the acute setting and can rapidly progress to a destructive process leading to significant long-term disability and pain. Multimodal imaging plays a key role in facilitating prompt diagnosis and treatment, and early imaging should be performed in PWID presenting with signs or symptoms suspicious for osteomyelitis [ 17 , 18 ]. Osteomyelitis due to haematogenous spread tends to result in a slow, insidious progression of symptoms whereas osteomyelitis from direct local extension presents with more pronounced and aggressive local manifestations.…”

“…Osteomyelitis due to haematogenous spread tends to result in a slow, insidious progression of symptoms whereas osteomyelitis from direct local extension presents with more pronounced and aggressive local manifestations. Given its insidious onset, primary or metastatic malignancy is an important differential for haematogenous osteomyelitis, particularly Ewing’s sarcoma in young adults [ 17 , 19 ]. In adults, haematogenous osteomyelitis typically involves the spine and is rare at other sites [ 17 ].…”

Tibiaschaftfrakturen

“…Ihr Einsatz ist eher zur Erfassung von Komplikationen wie z. B. Infekten (Markraumphlegmone, Weichteilabszesse), assoziierten Bandrupturen und Gelenkbinnenschäden sowie in Einzelfällen bei kindlichen Frakturen indiziert [10].…”

Diagnostic and Therapeutic Characteristics in the Approach of Diabetic Foot in the Elderly.

“…The sclerotic cavity surrounding the bony sequestration is called osseous implication. If the latter communicates with the soft tissues, it is recognized as a cloaca and worsens the prognosis of elderly patients with diabetic foot (6). All these alterations are related to the structural pathology that is triggered in Charcot's osteopathy.…”