Category | Post-test probability of osteomyelitis | Management advice | Criteria |
---|---|---|---|
Definite | > 90% | Treat for osteomyelitis | Bone sample with positive culture AND positive histology OR Purulence in bone found at surgery OR Atraumatically detached bone fragment removed from ulcer by podiatrist/surgeon OR Intraosseous abscess on MRI OR Any two probable criteria OR one probable and two possible criteria OR any four possible criteria below |
Probable | 51–90% | Consider treating | Visible cancellous bone in ulcer OR MRI showing bone edema with other signs of osteomyelitis OR Bone sample with positive culture but negative or absent histology OR Bone sample with positive histology but negative or absent culture OR Any two possible criteria below |
Possible | 10–50% | Treatment may be justified, but further investigation usually advised | Plain X-rays show cortical destruction OR MRI shows bone edema or cloaca OR Probe to bone positive or visible cortical bone OR ESR > 70 mm/hr. with no other plausible explanation OR Non-healing wound despite adequate offloading and perfusion for >6 weeks or ulcer of >2 weeks duration with clinical evidence of infection |
Unlikely | < 10% | Usually no need for further investigation or treatment | No signs or symptoms of inflammation AND normal X-rays AND ulcer present for <2 weeks or absent AND any ulcer present is superficial OR Normal MRI OR Normal bone scan |