Osteomyelitis natural history, complications and prognosis

Symptoms begin several days to weeks after infection. Symptoms lasting approximately less than 14 days is considered acute osteomyelitis, while longer lasting symptoms constitute chronic osteomyelitis. Acute symptoms include a prodrome accompanied by local erythema, edema, warmth, and pain.

Patients with chronic osteomyelitis develop sinus tracts or sequestra. Bearing weight may become increasingly difficult and patients may develop soft tissue ulcers, nonhealing fractures, and Brodie’s abscess. Complications include bone destruction, amputation, contiguous infection of joints or soft tissue, impaired bone growth in children, neoplasm, or tumor. Prognosis is generally good for acute osteomyelitis but usually poor for patients with chronic osteomyelitis.

• Acute infection is typically defined as symptoms lasting less than 14 days and if left untreated it may lead to chronic osteomyelitis.^[1]

• Patients typically develop prodromal symptoms after several days such as fever, malaise, irritability, lethargy, and chills.
• Local symptoms soon follow the prodrome and include erythema, edema, warmth, and pain.

• Chronic osteomyelitis is defined as the presence or recurrence of symptoms for greater than 4 weeks.

• Patients with chronic osteomyelitis may develop sequestra.
• Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult.
• Patients may develop soft tissue ulcers, nonhealing fractures, and Brodie’s abscess.^[2]

The following complications can occur:^[3][4]

• Sepsis
• Bone destruction
• Pathologic fractures
• Limb amputation
• Depending on the location of osteomyelitis, local extension of an invasive, suppurative process can lead to septic arthritis, brain abscess, meningitis, spinal cord compression, pneumonia, and empyema.
• Impaired bone growth in children
• Sinus tract formation may be associated with neoplasms, especially in the setting of longstanding infection.^[5][6][7]

• Most common: squamous cell carcinoma
• Less common: fibrosarcoma, myeloma, lymphoma, plasmacytoma, angiosarcoma, rhabdomyosarcoma, and malignant fibrous histiocytoma

• With treatment, the outcome for acute osteomyelitis is usually good.^[8]
• Prognosis is usually poor for patients with chronic osteomyelitis, even with surgery.

• Amputation may be needed, especially in those with diabetes or poor blood circulation.
• Patients with chronic osteomyelitis may have recurring symptoms after treatment.

• The outlook for those with an infection of an orthopedic prosthesis depends on:

• The patient’s immunity status
• The type of infection
• Whether the infected prosthesis can be safely removed