Osteomyelitis

By the WoundSource Editors Complex wounds pose a significant challenge for many health care providers. These wounds are often multifaceted, making treatment tremendously difficult. They represent a substantial burden on the health care industry, with annual costs in North America alone estimated at $10 billion annually. They often also result in patient discomfort and pain, caregiver frustration, individual economic losses, and diminished quality of life.

by the Wound Source Editors Chronic non-healing wounds affect millions of patients each year and contribute significantly to their morbidity and mortality. These wounds have a substantial impact because of their economic burden and the significant effect on the reduction in quality of life, as well as the increased risk of death for those patients affected by them.1 A 2014 study of Medicare data showed that chronic non-healing wounds and associated complications affect nearly 15% or 8.2 million Medicare beneficiaries. The study also estimated the cost to treat these wounds at between $28.1 billion and $31.7 billion annually.2 The highest costs were associated with infected or reopened surgical wounds, and outpatient care had the highest site-of-service costs. In addition to being older, most of these patients have obesity and diabetes. Underlying causes often include diabetic foot ulcers, venous leg ulcers, arterial insufficiency, and pressure ulcers. The list of complications contributing not only to chronicity but also to further deterioration is quite lengthy.

by the WoundSource Editors Venous leg ulcers (VLUs) are difficult to treat, and when they are present a variety of complications may arise. These complications can be challenging to treat and may often contribute to the prolonged healing times resulting from chronicity found with many VLUs. Further, if the condition of the ulcer deteriorates, it may worsen any complication already present or serve as the catalyst for the development of complications.

By Aletha Tippett MD Typical treatment when osteomyelitis (bone infection) is discovered is to plan a surgical treatment, usually wide debridement, but up to and including amputation. I was recently treating an 80-year-old with a wound on her foot that was healing very well. But she went to a hospital for a UTI and they found osteomyelitis under that foot wound. After much discussion they convinced her amputation was the only way, so her leg was amputated and she is now in a nursing home.

Editor's Note: In this interview, Ronald Sherman, DPM, MBA, and Christopher Abularrage, MD, address the steps they take to treat infected diabetic foot wounds of varying degrees, including those with osteomyelitis.

By Temple University School of Podiatric Medicine Journal Review Club One of the most severe complications of the diabetic foot is diabetic osteomyelitis. The diagnosis of diabetic foot osteomyelitis requires clinical suspicion of infection, and an associated soft tissue infection only increases the likelihood of confirming diabetic foot osteomyelitis. That said, there are still challenges in the diagnosis of osteomyelitis, such as a bone infection without the clinical manifestations of infection. This occurs in approximately half of all hard-to-heal osteomyelitis cases. Currently, the tests used to confirm a diagnosis of diabetic foot osteomyelitis include a probe-to-bone test, radiography, magnetic resonance imaging (MRI), and bone biopsy. Laboratory tests are also used to confirm the diagnosis of diabetic foot osteomyelitis, with the most important biomarker being erythrocyte sedimentation rate (ESR).

By Temple University School of Podiatric Medicine Journal Review Club Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN Osteomyelitis is an infection of the bone that usually requires surgical intervention. What about the patient who presents with comorbidities that prevent the patient from having surgical intervention? Studies conducted in diabetic foot ulcers have indicated that patients can receive adequate healing of osteomyelitis with antibiotic therapy as opposed to surgical intervention.