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Old 10-11-2012
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Arrow Gyrus Daily Questions; Orthopedics #1

A 67 year old man with diabetes and peripheral arterial disease comes in having had pain in his leg for two weeks.There is an ulcer with a draining sinus tract.The x ray is normal .What is the next best step in determining a diagnosis?

A. Bone scan
b. CT scan
C. MRI
d. ESR
e. Biopsy
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c. Mri..........
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If the x ray is normal and still suspicious of OM the best next step is MRI
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E
He has ostemyelitis
If this sinus track had been present for years or several months then a marjolin ulcer would be high on the differential
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Yes answer is correct MRI.

The MRI is the next best test to do to determine the diagnosis of osteomyelitis if the X ray is normal. a bone scan does not have the specificity of an MRI.

Bone scan is very poor at being distinguishing between infection of bone and soft tissue.

Both are equally sensitive.But MRI is more specific.
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I wanted to say Biopsy, but biopsy what?
draining sinus tract - is that from the bone for sure? Not necessarily, diabetics get ulcers all the time. You biopsy it and you find staph - 100% guaranteed... but thats from the skin.

MRI to rule out bone lytic lesion.
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Quote:
Originally Posted by DocSikorski View Post
I wanted to say Biopsy, but biopsy what?
draining sinus tract - is that from the bone for sure? Not necessarily, diabetics get ulcers all the time. You biopsy it and you find staph - 100% guaranteed... but thats from the skin.

MRI to rule out bone lytic lesion.
If chronic draining sinus tract is seen on an ulcer, for example diabetic ulcer OR chronic draining osteomyelitis; chronic of course meaning several months then Squamous cell carcinoma AKa Marjolin ulcer then you have to perform a punch out biopsy to rule it out.
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