OSTEOMYELITIS IN THE CHRONIC WOUND

A patient presents with a chronic diabetic heel ulcer that has worsened over the past few weeks.  Could this be osteomyelitis?

It turns out that physical examination findings can significantly raise or lower the probability of this diagnosis. According to JAMA’s rational clinical examination series (Butalia 2008), 2 findings on physical examination have more powerful likelihood ratios than MRI:

-A crater breadth of 2 square cm or more has a positive LR of 7.2.

-Probing to bone has a positive LR of 6.4.

Take Home Points:

Osteomyelitis is more likely when the chronic wound is more deep and more broad

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