Assessment Strategies to Improve the Diagnosis of Osteomyelitis in Diabetic Foot Using Radiography

Abstract

Background: Diabetes mellitus is a multi-system disease that affects people of both genders and any age or ethnic group. Foot wounds are common and can lead to loss of limb in cases of therapeutic failure. Aim: The aim of this study was to correlate initial diagnoses of osteomyelitis by radiography with bacterial cultures and identify ways to improve the diagnosis using this method. Method: In a prospective random clinical trial, the correlation between radiographs and bacterial cultures were evaluated in diabetic patients undergoing amputation of toes or part of the foot in Hospital de Base in the period from October 2010 to January 2012. Radiographs were considered suggestive of osteomyelitis if they identified an irregular bone surface, obliteration, bone resorption or periosteal resorption. The diagnostic impression from imaging was compared to the results of a bacterial growth culture prepared using bone removed during surgery. Results: An analysis of the radiographs identified 29 patients with results that were suggestive of osteomyelitis. Of these, the results of 27 bacterial cultures were positive. Eight of the 22 radiographs that were not suggestive of osteomyelitis were negative and 14 were positive. Conclusion: The diagnosis of osteomyelitis in diabetic foot can be improved by stratifying the results, taking the positive results and creating a diagnostic window with another diagnostic evaluation in cases that are initially negative.