Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Osteomyelitis Osteonecrosis 1105

follow-up

■In acute hematogenous osteomyelitis clinical response seen in 48–72

hours; response slower in other forms

■X-rays every 1–2 months may be helpful, but radiographic improve-

ment lags behind clinical response

■Sedimentation rate falls with therapy, but may take months to nor-

malize

■Most important follow-up is careful clinical assessment after antibi-

otics completed

complications and prognosis

■Soft tissue abscesses, extension of infection into adjacent joints,

epidural or psoas abscesses (in vertebral osteomyelitis) require sur-

gical intervention.

■Osteomyelitis associated with vascular insufficiency and diabetes

requires some form of amputation in up to 50% over long term.

■Hematogenous osteomyelitis has excellent prognosis, but inade-

quate or delayed therapy can result in chronic disease.

OSTEONECROSIS

MICHAEL WARD, MD

history & physical

History

■Alcohol use

■Corticosteroid use

■Trauma or femoral neck fracture

■Sickle cell disease, thalassemia

■Gaucher, Cushing’s, Caisson (diver’s) disease

■Radiation therapy

■SLE

■Chronic renal failure

■Pancreatitis

■Pregnancy

■Gout

■Coagulopathy

■Hyperlipidemia

■Diabetes mellitus

■Marrow-infiltrating tumors (leukemia, lymphoma)

■Congenital hip dislocation, slipped capital femoral epiphysis