Osteomyelitis

Case history #1

A 40-year-old man who suffered an open tibial fracture in a motor vehicle accident 6 months ago presents with swelling and pain in his lower leg.

Case history #2

A 5-year-old boy fell off his bicycle 2 weeks ago, has stopped walking, and complains of non-specific leg pain. His mother reports that he apparently has had flu, with fever and chills.

Other presentations

Symptoms of osteomyelitis vary with the duration of the disease and may have a gradual onset over several days.

Acute osteomyelitis typically presents acutely, with bone pain, tenderness, warmth, and swelling in the affected region and systemic symptoms. Pain may occur with or without movement. This classic presentation does not occur in all cases. Some sites, such as the vertebrae or pelvis, may present a diagnostic challenge with a systemically unwell patient displaying signs of sepsis but without clear localising signs.

Chronic osteomyelitis is generally associated with a longer duration of symptoms. The pain may be less severe, with minimal fever and fewer constitutional symptoms. There is often a history of a discharging sinus or signs of old, healed sinuses, soft-tissue abscesses, or scars from previous surgery or injury. The patient may have lived with discharging sinuses for years, having previously been told that there is nothing that can be done for the problem.

Chronic osteomyelitis may produce long-term ill health with weight loss, malaise, fatigue, or depressed mood. Acute systemic upset is less common, but pyrexia, sweating attacks, and anorexia are associated with flare-ups of the disease.