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Author: Mikael Häggström [note 1]

Gross processing

  • Measure the specimen.
  • Bisect clinically or visibly suspected areas, in longitudinal direction when possible.
  • Fix the specimen in formalin.
  • Decalcify the specimen.
  • Sample from:
  • Visibly affected areas
  • Proximal surgical bony margin, if present, inked and as a longitudinal section.

Microscopic evaluation

The main sign of acute osteomyelitis is the presence of numerous neutrophils in the stroma. It may also have lymphocytes, plasma cells, bone necrosis,' capillary proliferation and fibrosis.[1]

Further workup

Green mark made at significant osteomyelitis inflammation.

For toe amputations, determine its extent, particularly compared to the bony surgical or articular margin. Start at the margin and scan the bone at at least intermediate magnification until significant inflammation is seen. Preferably make a mark there and measure the distance from the mark to the margin.

Microscopic report


(A. Left third toe, amputation:)
Toe with ulcer and osteomyelitis. Osteomyelitis involves the distal phalanx, middle phalanx and proximal phalanx.
Osteomyelitis is 2.0 cm from the proximal articular surface of the proximal phalanx.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page


  1. Dariusz Borys. Bone & joints - Osteomyelitis - Bacterial osteomyelitis (acute). PathologyOutlines. Topic Completed: 1 June 2012. Minor changes: 28 June 2019

Image sources