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doi: 10.3810/psm.2008.12.11
The Physician and Sportsmedicine: Volume 36: No.1
Approach to Diagnosis and Treatment
Joseph M. Fritz, MD and Jay R. McDonald, MD
Abstract: Osteomyelitis has traditionally been classified into 3 categories.1 The first category, hematogenous osteomyelitis, is a bone infection that has been seeded through the bloodstream. The second, osteomyelitis due to spread from a contiguous focus of infection without vascular insufficiency, is seen most often after trauma or surgery, and is caused by bacteria that gain access to bone by direct inoculation (eg, a contaminated compound fracture) or extension to bone from adjacent contaminated soft tissue (eg, a prosthetic joint contaminated at the time of implantation). The third category, osteomyelitis due to contiguous infection with vascular insufficiency, is seen almost exclusively in the lower extremities, most commonly as a diabetic foot infection. Each of these 3 categories of osteomyelitis can present in the acute or chronic phase, in virtually any bone, caused by a variety of bacteria and, occasionally, fungi. Thus, the approach to osteomyelitis should be guided by several principles, but must be individualized to each unique situation.