title: Infected puncture wounds in adults with diabetes: risk factors for osteomyelitis.
abstract: The purpose of this study was to investigate factors that contribute to the development of osteomyelitis of the foot after a puncture wound in patients with diabetes. Forty-five male and 21 female adults with diabetes that were admitted to the hospital for a foot infection precipitated by a puncture were included in the study. Twenty-two (33%) patients had osteomyelitis (O) based on either a positive bone culture or pathology report. Forty-four patients had soft tissue infections (ST). Age and duration of diabetes were similar in both groups. Patients with osteomyelitis received medical treatment later than patients with soft tissue infections. A significant difference was identified when comparing the time interval from the time of the injury until patients were hospitalized and until they had the puncture wound surgically debrided, and when comparing the interval from when patients first received initial professional medical evaluation until they were hospitalized and until they had the puncture wound surgically debrided. Patients with punctures involving the forefoot (FF) and patients that wore shoes (S) at the time of the injury were more likely to develop osteomyelitis than patients that had rearfoot (RF) injuries O: FF = 20, 90%, RF = 2, 10%, ST: FF = 30, 70%, RF = 13, 30%, p < 0.05) and patients that were barefoot (B) at the time of injury (O: S = 15, 88%, B = 2, 12%, ST: S = 21, 57%, B = 16, 43%, p < 0.05). Osteomyelitis is a common complication in patients with diabetes with a foot infection following a puncture wound.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Orthopedics, University of Texas Health-Science Center at San Antonio.
authors.forename: L A
authors.initials: LA
authors.lastname: Lavery
authors.forename: L B
authors.initials: LB
authors.lastname: Harkless
authors.forename: H R
authors.initials: HR
authors.lastname: Ashry
authors.forename: K
authors.initials: K
authors.lastname: Felder-Johnson
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement; D048909:Diabetes Complications; D005260:Female; D005534:Foot Diseases / Q000209:etiology*; D018409:Foot Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005545:Forefoot, Human / Q000293:injuries; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology*; D012307:Risk Factors; D012775:Shoes; D018461:Soft Tissue Infections / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors; D014946:Wound Infection / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014950:Wounds, Penetrating / Q000150:complications* / Q000175:diagnosis / Q000601:surgery