Primary subacute osteomyelitis of the axial and appendicular skeleton

Subacute osteomyelitis is not uncommon. Owing to its insidious onset, mild symptoms, and inconsistent supportive laboratory data, diagnosis and treatment are usually delayed. We report a retrospective review of 28 consecutive patients with subacute hematogenous osteomyelitis. Based on a review of the literature and our experience, we reached the following conclusions: Recognition of the subacute form of osteomyelitis as a separate clinical condition distinct from the acute form will lead to early institution of an aggressive, conservative treatment protocol. We adopted Robert’s modification of Gledhill’s classification, but believed that one type of radiologic presentation was missing and should be added as type VII–that is, sclerosis of flat bones with neither erosive nor destructive processes. This disease responds very favorably to appropriate antibiotic therapy. Surgery should be reserved for persistent infection symptoms despite appropriate therapy or performed when lesions are indistinguishable from bone tumors by use of all available imaging modalities.