Osteomyelitis  

12/22/98 (Del Rio)

Question: What is the value of bone biposy in the diagnosis of osteomyelitis of the hand and what is the microbiology in hand osteomyelitis?

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Unique Identifier 97407387 

Authors: Reilly KE. Linz JC. Stern PJ. Giza E. Wyrick JD. 

Institution: Department of Orthopaedic Surgery, University of Cincinnati, OH, USA.  

Title: Osteomyelitis of the tubular bones of the hand.

Source: Journal of Hand Surgery - American Volume. 22(4)644-9, 1997 Jul.  

Abstract: The records of 700 patients with hand infections were reviewed. Forty-six (6%) had osteomyelitis of the metacarpals or phalangeal bones. The cause was post-traumatic in 57%, postoperative in 15%, hematogenous in 13%, spread from contiguous infections in 9%, and unidentified in 6%. Twenty-two percent of the patients had vascular insufficiency and/or were immunocompromised. History, physical exam, plain x-rays, and open biopsy and culture were most helpful in establishing the diagnosis. Laboratory studies and bone scans were less helpful. Cultures were positive in 74% of patients, with a noteworthy number of mixed infections (35%) and gram-positive infections (35%). Gram-negative infections accounted for 15%, fungal infections for 12%, and mycobacterial infections for 3%. Surgical management varied from simple curettage to more elaborate staged reconstructions and/or arthrodeses. Despite provision of aggressive surgical care and use of appropriate antibiotics, the overall amputation rate was 39% (18/46). A delay of more than 6 months from onset of symptoms to diagnosis and definitive treatment led to amputation in 6 of 7 patients (86%), 2 of whom had squamous-cell carcinoma. Of the 12 patients who underwent more than 3 surgical procedures, 8 ultimately underwent amputation and 2 had marked disability. 

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Unique Identifier 91258384 

Authors Perry CR. Pearson RL. Miller GA. 

Institution Washington University School of Medicine, St. Louis, Missouri. 

Title: Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis.

Source Journal of Bone & Joint Surgery - American Volume. 73(5):745-9, 1991 Jun. 

Abstract The pathogens that were identified on cultures of material obtained by swabbing of the superficial aspect of the wound and needle biopsy were compared with those that were isolated from material that was obtained at debridement from sixty patients who had post-traumatic or postoperative osteomyelitis. The cultures of material that was obtained by superficial swabbing of the wound and needle biopsy were inadequate for prediction of the presence of aerobic organisms. Moreover, the failure to isolate anaerobes from the material obtained by needle biopsy did not rule out the presence of anaerobic organisms. Therefore, tissue for culture of aerobic and anaerobic organisms must be obtained during operative debridement in order to identify all pathogenic organisms. Fungi were isolated from the material obtained by biopsy in two patients. In addition, histological examination of the tissue obtained at biopsy led to the diagnosis of epidermoid carcinoma in two patients in whom this diagnosis had not been suspected before biopsy. Cultures were negative for mycobacteria in all patients. An additional ten patients who had a tibial non-union and latent osteomyelitis were studied. In nine of them, cultures of material obtained by needle biopsy showed no growth. Six of these nine patients had an exacerbation of the osteomyelitis after intramedullary nailing for the non-union. Therefore, the absence of growth of organisms from tissue obtained at needle biopsy does not rule out the possibility that osteomyelitis may be reactivated after intramedullary nailing with reaming.  

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Unique Identifier 97222384 

Authors: Lew DP. Waldvogel FA. 

Institution: Department of Medicine, Geneva University Hospital, Switzerland.  

Title: Osteomyelitis [Review] [62 refs]

Source: New England Journal of Medicine. 336(14)999-1007, 1997 Apr 3.  [see comments]

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