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Overview of osteomyelitis in adults

Tahaniyat Lalani, MBBS, MHS
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Osteomyelitis is one of the oldest recorded diseases, with descriptions dating back to the time of Hippocrates (460 to 370 BC) [1]. Terms such as "abscessus in medulla," "necrosis," and "a boil of the bone marrow" were used to describe the infection until Nélaton introduced the term "osteomyelitis" in 1844.

In the pre-antibiotic era, the management of acute osteomyelitis was purely surgical, with large incisions for removal of all necrotic bone [1]. Wounds were packed with Vaseline gauze and left to heal by secondary intention after immobilization. Mortality rates remained high (about 33 percent) due to sepsis until the introduction of penicillin in 1940, which dramatically changed the treatment and prognosis of osteomyelitis. Complications such as sequestration, sinus formation, and sepsis became less common, and the goals of therapy changed from disease containment to cure.

Issues related to epidemiology, pathophysiology, classification, microbiology, clinical manifestations, diagnosis, and treatment of osteomyelitis are presented here. Issues related to diabetic foot infections as well as osteomyelitis in the setting of trauma, vertebral osteomyelitis, and hematogenous osteomyelitis are reviewed in detail separately. (See "Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities" and "Treatment and prevention of osteomyelitis following trauma in adults" and "Vertebral osteomyelitis and discitis in adults" and "Hematogenous osteomyelitis in adults".)


Osteomyelitis can occur as a result of hematogenous seeding, contiguous spread of infection to bone from adjacent soft tissues and joints, or direct inoculation of infection into the bone as a result of trauma or surgery. Hematogenous osteomyelitis is usually monomicrobial, while osteomyelitis due to contiguous spread or direct inoculation is usually polymicrobial.

In long-bone hematogenous osteomyelitis, the most common site of infection is in the metaphysis. The major blood vessel to long bones usually penetrates the midshaft of the bone and then travels toward both ends, forming metaphyseal vascular loops just before it hits the epiphyseal plates. Slowed blood flow in these loops (together with the absence of basement membranes) predisposes this site to osteomyelitis. (See "Hematogenous osteomyelitis in adults".)

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Literature review current through: Nov 2017. | This topic last updated: Feb 21, 2017.
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