The patient’s history is important in establishing a diagnosis of osteomyelitis. Common history findings include intravenous drug use, bacteremia, recent open fracture or surgery, and diabetes. Common symptoms include chills, fever, malaise, local pain and warmth, edema, and erythema. Fever is typically absent in diabetic patients with osteomyelitis secondary to vascular insufficiency and in patients with infected prosthesis. The presence of a draining sinus tract is pathognomonic of chronic osteomyelitis.

A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient based on specific types of osteomyelitis include:

• Hematogenous Osteomyelitis:

• Intravenous drug use^[1]
• Urinary catheter use
• Bacteremia

• Contiguous-focus Osteomyelitis:

• Recent open fracture
• Recent surgery, especially orthopedic surgery
• Prosthesis

• Osteomyelitis secondary to vascular insufficiency:

• Diabetes^[2]
• Diabetic patients with soft-tissue inflammation or skin ulcers in the feet

• Systemic:^[3][4]

• Chills
• Headache
• Fatigue
• Anorexia
• Fever
• Malaise

• Local:

• Pain
• Edema
• Erythema
• Warmth

• Diabetic patients with osteomyelitis secondary to vascular insufficiency typically do not have fever or inflammation.^[5]
• Diabetic patients with advanced neuropathy may not feel pain.
• Fever is typically absent in patients with infected prosthesis.
• Patients with vertebral osteomyelitis may have generalized neck and back pain.
• The presence of a draining sinus tract is pathognomonic of chronic osteomyelitis.