Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases

Abstract

Background. Currently, both clavicular bacterial osteomyelitis (BO) and nonbacterial osteitis (NBO) remain not well understood owing to their much lower incidences. This study is aimed at summarizing similarities and differences between clavicular BO and NBO based on comparisons of literature-reported cases. Methods. We searched the PubMed and Embase databases to identify English published literature between January 1st, 1980, and December 31st, 2018. Inclusion criteria were studies evaluating clinical features, diagnosis, and treatment of clavicular BO and NBO, with eligible data for synthesis analysis. Results. Altogether, 129 studies with 327 patients were included. Compared with BO, clavicular NBO favored females ( P < 0.001 ) and age below 20 years ( P < 0.001 ) and mostly presented in a chronic phase (disease term exceeding 2 months) ( P < 0.001 ). Although local pain and swelling were the top two symptoms for both disorders, fever, erythema, and a sinus tract were more frequently found in BO patients ( P < 0.01 ). Although they both favored the medial side, lesions in the clavicular lateral side mostly occurred in BO patients ( P = 0.002 ). However, no significant differences were identified regarding the serological levels of white blood cell count ( P = 0.06 ), erythrocyte sedimentation rate ( P = 0.27 ), or C-reactive protein ( P = 0.33 ) between BO and NBO patients before therapy. Overall, the BO patients achieved a statistically higher cure rate than that of the NBO patients ( P = 0.018 ). Conclusions. Females, age below 20 years, and a long duration of clavicular pain and swelling may imply NBO. While the occurrence of a sinus tract and lesions in the lateral side may be clues of BO, inflammatory biomarkers revealed limited values for differential diagnosis. BO patients could achieve a better efficacy than the NBO patients based on current evidence.

Sternoclavicular Septic Arthritis Caused by Cutibacterium acnes in a Previously Healthy 13-Year-Old Male

“…Bony and skin lesions, however, may not be present at the same time, and a thorough history and physical examination are necessary to aid in the diagnosis. A recent systemic review of clavicular inflammatory disorders reported that females, age below 20 years, and symptoms exceeding 2 months were more commonly found in nonbacterial etiologies of clavicular osteitis 11 . Nonetheless, our patient's onset of symptoms that were not responsive to anti-inflammatory therapy as well as his negative history of skin disorders or involvement of his skin on presentation and at the final follow-up made the diagnosis of SAPHO syndrome less likely.…”

Chronic Nonbacterial Osteomyelitis of the Jaw in a 3-Year-Old Girl

“…The pathogenesis of CNO and SAPHO may be driven by cutibacterium (formerly propionibacterium) acnes [ 5 ]. Thus, the differential between bacterial osteomyelitis (BO or BOM) and nonbacterial osteitis (NBO) is a challenge [ 6 ]. Additionally, the development of CNO may be associated with skin infection or mucocutaneous disease [ 7 ].…”