Acute hematogenous osteomyelitis in intravenous drug users.

The authors report a case of acute hematogenous osteomyelitis in a closed metatarsal fracture of an adult intravenous drug user. A transient Staphylococcus aureus bacteremia documented by blood cultures was sustained that presumably seeded the existing fracture. Osteomyelitis was documented by intraoperative cultures that matched the blood cultures and a Technetium-HMPAO-labeled leukocyte scan. Reliance on a noncompliant patient for information may have been a factor that resulted in significant morbidity in this case. Although the patient managed to do well after surgical intervention, osteomyelitis may have been avoidable. Treatment and a self-critical review of the approach to this patient population and decisions made in this case are also discussed.