Review Question - QID 107280

A 55-year-old woman with a history of diabetes with medication noncompliance presenting with chronic fevers and diabetic ulcer is concerning for osteomyelitis. The best test for osteomyelitis is a technetium bone scan during which uptake would show osteoblastic and vascular activity. It is treated with long-term intravenous antibiotics with to without surgical debridement.

Osteomyelitis is an infection of the bone that most often occurs with overlying wounds in immunocompromised patients (diabetics, patients on immunotherapy, transplant patients, etc). In immunocompetent individuals, osteomyelitis occurs with deep wounds such as puncture wounds (by metals or animals) or large open wounds (such as open fractures).

Figure A illustrates a diabetic ulcer in the patient's left foot without an obvious area of collection or erythema in the surrounding skin. Figure B shows AP views and lateral radiographs of the ankle along with the tibia and fibula. There are numerous lucencies on the radiographs significant for intraosseous abscesses. Illustration A shows an example of a normal technetium bone scan of a patient's whole body. In osteomyelitis, one would see osteoblastic and vascular activity on bone scan evidenced by dark collection of nuclear isotopes. Illustration B is an example of Charcot arthropathy of the ankle as evidenced by a grossly deformed ankle on the radiograph.

Incorrect Answers:
Answer 1: A fracture is not visible on the films.
Answer 2: Area of interest demonstrates no erythema and cellulitis alone would not result in the changes on X-ray.
Answer 3: There is no fluctuance or fluid collection observed on exam, making abscess is less likely.
Answer 4: With diminished sensation and inadequate diabetes control, this patient may progress to a Charcot joint, but this deformity would not result in the patients symptoms.