Osteomyelitis, acute and chronic

Osteomyelitis is still a frequent cause of morbidity in the United States. The pre-eminent item of importance for patient care is the early diagnosis. The treatment should be instuted promptly when an aggregate knowledge of the radionuclide studies and radiographs is commensurate with the clinical assessment. There has been a striking decrease in the overall mortality to 2 per cent since 1943, due to progressive improvement in its consideration, detection, and therapy. Radionuclide bone imaging, especially with the three-phase bone scan, has had a significant impact on the radiologic evaluation of osteomyelitis. They help in detection and localization, so that early aggressive therapy can be initiated. False positive and false negative studies can occur: however, these discrepancies are minimized by a review of the patient's history, radiographic findings, and physical examination. Occasionally, a normal radionuclide bone image may be the result of scanning too early prior to the onset of reactive hyperemia. This is not infrequent in young infants due to a limited area of thrombosis or occlusion of the vascular channels secondary to edema. The activity of the lesion during treatment is best evaluated by (1) using gallium-67 citrate or indium-111 scanning in conjunction with the three-phase bone scan, and (2) we advise a follow-up gallium-67 citrate scan in conjunction with conventional radiographs to confirm healing and to obviate the concern of an indolent chronic osteomyelitis. One should always be cognizant of patients who are at high risk, so that an appropriate index of suspicion is kept in mind and early or even occult disease uncovered.