Diagnosis and Treatment Modalities for Osteomyelitis

Abstract

Osteomyelitis is an infection-related inflammatory disease of the bones. Imaging and laboratory results are typically used to support a clinical diagnosis of osteomyelitis. Microbial cultures and bone biopsies provide conclusive diagnoses. The first imaging procedure that needs to be done is radiography, but its sensitivity is low in the early stages of the disease. The sensitivity of magnetic resonance imaging, both with and without contrast material, is higher for detecting areas of bone necrosis in advanced stages. Patients can be categorised for surgical treatment using a staging system based on major and minor risk factors. The main course of treatment should be antibiotics, which should be chosen depending on the findings of the culture and the characteristics of each patient. Bony debridement surgery is frequently required, and in high-risk patients or those with severe illness, additional surgical intervention can be necessary. Better outcomes are being attained in the treatment of this illness thanks to advancements in surgical treatment, antibiotic therapy, and the current resources for precise diagnosis and tailored responses to each kind of osteomyelitis. The classification systems that are most frequently employed, as well as the general epidemiological ideas, are presented together with the discussion of acute and chronic osteomyelitis. The key recommendations for diagnosing infections clinically, in the laboratory, and through imaging are covered, along with the recommendations for surgical and antibiotic procedures, and the function of hyperbaric oxygen as adjuvant therapy. We evaluate the osteomyelitis-related articles, summarise the most recent developments in diagnostic procedures and therapeutic regimens, evaluate the benefits and drawbacks of various diagnostic modalities and therapeutic approaches, and suggest areas of focus to help current diagnostic and therapeutic approaches.

Keywords: chronic osteomylitis; diagnosis of osteomylitis; osteomylitis; treatment of osteomylitis; vertebral osteomylitis.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2022, Jha et al.

Figures

Figure 1. Chronic osteomyelitis of the tibia in a 16-year-old female

Images taken through (A) conventional radiography (B) CT scan (C) MRI (D) MRI. Image taken by Yash Jha.

Figure 2. Staphylococcus aureus osteomyelitis in a 20-year-old man.

Images taken through (A) conventional radiograph (B) MRI coronal T1w (C) axial T2w fat-saturated (D) show a permeative lesion of the left femoral shaft; (E) CT scan.

Figure 3. X-ray of leg showing osteomyelitis in the fibula

Image taken by Yash Jha.

Figure 4. X-ray of leg showing osteomyelitis in the tibia

Image taken by Yash Jha.

Figure 5. MRI of leg showing osteomyelitis in the right tibia

Image taken by Yash Jha.

Figure 6. MRI of leg showing osteomyelitis in the tibia

Image taken by Yash Jha.

Figure 7. CT of leg showing osteomyelitis in the lower tibia

Image taken by Yash Jha.