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Osteomyelitis:
- An acute or chronic inflammatory, infectious process of bone. Can occur via hematogenous spread or direct innoculation of bone.
- Can be diagnosed on plain radiographs but bony changes might not be evident for 14-21 days. By 28 days 90% of patients will demonstrate a bony abnormality.
- Initially plain radiographs will show periosteal elevation. Later cortical or medullary lucencies are seen.
- Additional tests to help make the diagnosis include:
- Three phase bone scan: often not practical for the ED.
- CT Scan: better in areas with complex anatomy [i.e.:spine, pelvis, ,mid and hind foot]
- MRI: most effective in early detection and to guide surgical approaches. Sensitivity is estimated at 90-100%.
References
King RW, Johnson D: Osteomyelitis. In: eMedicine. WebMd; 2009.