We have a patient with a small ulcer on her ankle, which keeps healing up and then reopening again within a few weeks. Could this be osteomyelitis?
Because the ulcer is over a bony prominence, osteomyelitis is a potential complication. Osteomyelitis is an infection of the bone. This can occur when a wound located over a bone develops an infection and the infection eventually spreads into the bone. The less tissue between the wound bed and the underlying bone, the greater the likelihood that osteomyelitis will develop. In patients with infected diabetic ulcerations, underlying osteomyelitis is present in as many as two-thirds of these patients.
Symptoms of underlying osteomyelitis can include: bone pain, re-occurring wound infection, sinus tract issues, heavy purulent drainage and non-healing wound areas. The patient might also be completely symptom-free.
Bone biopsy has long been considered the gold standard in the diagnosis of osteomyelitis, but several other methods also are used, including MRI, CT scans, X-rays along with lab testing of Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP).
Typically, the treatment of osteomyelitis consists of debridement of infected tissue and bone, along with a four- to six-week regimen of IV antibiotics. Some recent studies have shown the use of a shorter course of IV antibiotics followed by a longer course of oral antibiotics without bone debridement to also be effective.
However, in the end, if underlying osteomyelitis is present and not treated, the wound will continue to open and close and never fully heal. If the patient is not a candidate for treatment, the care plan and medical record should be updated to reflect a maintenance plan instead of a goal for complete healing.
From the January 01, 2010 Issue of McKnight's Long-Term Care News
