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Osteomyelitis is a serious bacterial infection of bone tissue that can occur through hematogenous spread, direct inoculation, or contiguous spread from adjacent soft tissues. It commonly affects long bones in children and vertebrae or diabetic foot bones in adults, requiring prompt diagnosis and prolonged antibiotic therapy to prevent complications.
Bacterial pathogens, most commonly Staphylococcus aureus, invade bone tissue and establish infection within the medullary cavity or cortex. The inflammatory response leads to increased intraosseous pressure, compromised blood supply, and potential bone necrosis, while the formation of sequestra (dead bone) and involucra (new bone formation) can perpetuate chronic infection.
Diagnosis requires correlation of clinical presentation (bone pain, fever, local inflammation) with laboratory markers (elevated ESR, CRP, WBC) and imaging studies, progressing from plain radiographs to MRI for definitive assessment. Treatment involves obtaining tissue cultures when possible, followed by prolonged intravenous antibiotics (typically 4-6 weeks), with surgical intervention reserved for cases with abscess formation, sequestra, or treatment failure.
Key imaging focus: Bone marrow edema, periosteal reaction, sequestrum, involucrum, soft tissue abscess