Does this Patient with Diabetes have Osteomyelitis?
Diagnosis of lower extremity osteomyelitis in the diabetic patient remains challenging
Bone biopsy with culture remains the gold standard for diagnosis but is not always obtainable
What clinical features, therefore, raise the likelihood of osteomyelitis?
In this review, an ulcer size > 2 cm2 (LR 7.2), ability to probe to bone using a sterile stainless steel probe (LR 6.4), and an ESR > 70 mm/h were found to be useful in predicting the presence of osteomyelitis
Clinical features NOT found to be useful included fever (sensitivity 19%), presence of erythema, swelling, or purulence (LR 1), elevated white blood cell count (sensitvity 14%-54%), and superficial swab culture
A note about radiographic studies:
bony changes on plain films may take up to 2 weeks to develop
plain films alone are only marginally useful if positive (LR 2.3)
MRI is more accurate than bone scan or plain films
If you are going to order a radiographic study, your best bet is the MRI
References
Butalia S, Palda VA, Sargeant RJ, et al. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 2008;299:806-13.
