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Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Jan 24, 2007.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis: A Meta-analysis.
    Arch Intern Med. 2007 Jan 22;167(2):125-32
    Kapoor A, Page S, Lavalley M, Gale DR, Felson DT
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. rajna

    rajna Member

    This is great - but have you tried getting access to an mri? I work in a public hospital and inpatients have been discharged simply to access mri's as the current system pays more for outpatient access. In addition there is quite a waiting period to access the machine. There needs to be some way of being able to increase speed of access to patients with suspected osteomyelitis so that diagnosis can occur quickly and treatment implemented in a timely manner. Any ideas?
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Role of magnetic resonance imaging in the evaluation of diabetic foot with suspected osteomyelitis.
    Rozzanigo U, Tagliani A, Vittorini E, Pacchioni R, Brivio LR, Caudana R.
    Radiol Med. 2008 Oct 25. [Epub ahead of print]
     
  5. Greg Fyfe

    Greg Fyfe Active Member

    Interesting and relavant thread.

    I recently encountered a 35 yr old client , with diabetes,who was admitted to hospital 8 weeks ago and given i.v. antibiotics for an wound beneath the 1st ip joint.
    Unclear weather she was discharged with oral cover, certainly currently is not on any.
    . X rays have been taken twice and not demonstrated signs of osteomyelitis.
    I debrided the wound recently it had some hypergranulation tissue, modest exudate and nil odour. The toe is swollen apprx 2x normal size and the client denies any symptoms of systemic illness. The foot has good circulation and the HbA1c is over 12.

    In discussion with the visiting Dr ,he declined to prescribe any antibiotics but review the case in a couple of weeks. Logic being that as the wound had been reported as improving (therefore antibiotics were not nessecary) then if it was not progressing on next review an mri was nessecary before surgical debridement of the bone could be undertaken.

    As rjna points out the issues in accessing mri in a timely manner are significant, and perhaps there is a case for management on the basis of "clinical suspicion"

    Furthermore i feel the Dr's course of management is inappropriate or is it just me?

    I'd be interested in your views.

    Regards

    Greg
     
  6. drsarbes

    drsarbes Well-Known Member

    "This is great - but have you tried getting access to an mri?"

    hmmmmmmmmmmm

    I wish EVERYONE on the US of A could read this post. especially those who THINK they WANT National Health Care!!!

    Even in my smallish town of 100,000 we have several MRI centers having to MARKET themselves for utilization. In fact, if you so much as twist your knee you'll end up with an MRI.

    Steve
     
  7. Ryan McCallum

    Ryan McCallum Active Member

    Hi Greg,
    any further details on this case? Is the patient neuropathic? How longstanding is this ulceration? When were the x-rays taken? Other than her IV antibiotics, what other care has she received for this problem? Has there been input from any other departments? Has the patient had any recent blood tests?

    With a HbA1c of 12, I am not surprised this patient is still requiring care. Is her diabetes normally this poorly controlled? This needs to be sorted out ASAP.

    Where I work, we are quite lucky with the resources available to us but if we are caring for a patient on an inpatient basis, we routinely run CRP, FBC and take regular swabs. Relying on wound inspection and x-rays doesn't really provide enough information for me. We do not routinely request MR scans for cases suspicious of osteomyelitis (the orthopods on the other hand tend to request them all the time).

    I would be suspicious of osteomyelitis in this case you have described. Whether the Dr's management is inappropriate would depend on the bigger picture but I think your "clinical suspicion" counts for an awful lot!

    Look forward to hearing a few more details about this case,

    Regards,
    Ryan
     
  8. Greg Fyfe

    Greg Fyfe Active Member

    Hi Ryan

    No the patient is not neuropathic.

    Her diabetes is generally poorly controlled as she is not reliable about taking her medication.

    Im not sure how old the ulcer is as she first presented 8 weeks ago ( not to me) and at that stage the notes record that she was systemically unwell and maggots were present in the wound. It's probably 1.5-2 cm diameter and I cannot probe to bone.

    The x rays were close to the time of admission and 1 month later.

    The patient comes from a remote area that has resident nursing staff available and a visiting Dr about once a week it is some 6hrs drive to the nearest small town hospital.

    Im now wondering if she would be better managed in hospital as her bsl could be stabilised which I think would assist with wound management, although I guess that the admission criteria may require her to be more unwell.

    Thanks for your thoughts

    Cheers
    Greg
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Conservative management of diabetic forefoot ulceration complicated by underlying osteomyelitis: the benefits of magnetic resonance imaging.
    Valabhji J, Oliver N, Samarasinghe D, Mali T, Gibbs RG, Gedroyc WM.
    Diabet Med. 2009 Nov;26(11):1127-34.
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Efficacy of Magnetic Resonance Imaging in Diagnosing Osteomyelitis in Diabetic Foot Ulcers
    Miki Fujii, Hiroto Terashi and Shinya Tahara
    J Am Podiatr Med Assoc 104(1): 24–29, 2014
     
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