- Labs:
    - WBC, ESR, CRP;
    - gram stain and culture:
         - prior to giving antibiotics, it is essential that a gram stain and culture be collected;
                - in hematogenous osteomyelitis, a bone aspirate is required which can usually be performed w/ a 16 or 18 gauge needle;
                - in children, consider the need for open biopsy inorder to rule out tumor (such as EOG); 
                - need to culture material from sinus track, purulent material, soft tissue, of bone obtained from curettage, and specimens from the bed of  involved bone;
          - gram stain diff dx:
                - gram negative bacilli 
                - gram negative cocci 
                - gram positive bacilli 
                - gram positive cocci
         - references:
                - Quantitative wound cultures in upper extremity trauma.
                - Microbiologic flora contaminating open fractures: its significance in the choice of primary antibiotic agents and the likelihood of deep wound infection.
                - Comparison of the results of bacterial cultures from multiple sites in chronic osteomyelitis of long bones. A prospective study.
                - The significance of perioperative cultures in open pediatric lower-extremity fractures.
                - Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis. 
                - Laboratory monitoring in pediatric acute osteomyelitis and septic arthritis. 
                - The limping child: evaluation and diagnosis.
                - Does aspiration of bones and joints affect results of later bone scanning?

 - Radiographic Studies:
    - x-ray manifestations
    - MRI for osteomyelitis
    - radioisotope scanning
          - will be positive after 3 days of symptoms;
          - never delay a bone aspirate inorder to avoid artifacts on bone scan;
    - fluorine-18 fluorodeoxyglucose-positron emission tomography:
          - FFPET is an accurate imaging technique which is more accurate than the combination of a bone scan and a white blood-cell scan for the diagnosis of chronic infection of the spine; 
                - sensitivity, specificity, and accuracy were 100%, 88%, and 93% for the whole group; 
                - ref: Fluorine-18 Fluorodeoxyglucose-Positron Emission Tomography: A Highly Accurate Imaging Modality for the Diagnosis of Chronic Musculoskeletal Infections 
    - references:
          - Does aspiration of bones and joints affect results of later bone scanning? 
          - Diagnosis of infection in ununited fractures. Combined imaging with indium-111-labeled leukocytes and technetium-99m methylene diphosphonate.