Osteomyelitis

Definition

Osteomyelitis is the local or generalized infection of bone and bone marrow, usually caused by bacteria. It can be introduced by trauma, surgery, by direct extension from a nearby infection or via the bloodstream.

Description

Along with essential oxygen and nutrients, blood may also carry bacteria and other organisms which tend to settle in the capillaries (tiny blood vessels) of the long bones of the arms and legs. Infectious agents can also reach the bones directly from adjacent infected tissue or through an open wound or fracture. Osteomyelitis can attack more than one bone at a time.

It occurs in both children and adults, and is a serious infection that can be difficult to diagnose and treat.

Symptoms

These may include pain and excruciating tenderness near a joint or at the affected area, accompanied by redness, swelling, a fever in the range of 102 F to 104 F, and chills.

Diagnosis

In addition to taking a medical history and a physical exam, aspiration of the involved bone may be necessary. Culture of the blood or bone tissue is essential for a precise diagnosis. Radiographs (x-rays) early in the course of the infection may be falsely negative. MRI (magnetic resonance imaging) may be more helpful in demonstrating the extent of soft tissue involved.

Treatment

The treatment generally consists of surgical debridement (cleaning) of the infected bony and soft tissue structures, and the prolonged use of antibiotics. Until recently, these antibiotics have been given intravenously. Advances in oral antibiotic therapy have yielded newer agents that are able to penetrate into bone, and in many cases, are curative. This has markedly decreased the amount of hospitalization time needed for the osteomyelitis patient.

While oral agents may not have the same degree of success as intravenous antibiotics, certain elderly, debilitated or institutionalized patients might be ideal candidates for oral treatment. With either antibiotic regimen, however, complete surgical removal of the area is necessary to eradicate the infection.

Complications

Possible complications include septicemia (blood poisoning); destruction of the bone; the spreading of the infection to a nearby joint (possibly resulting in a permanent deformity); the spreading of the infection to the surface of the skin (where it erupts as an abscess); damage to the cartilage adjacent to the bone (which may retard bone growth); and suppurative (infectious) arthritis.

Chronic (long-term) osteomyelitis may be a delayed complication of acute (sudden onset) osteomyelitis, especially if it results from a fracture or the presence of a foreign body in the wound, such as a bullet or a piece of metallic debris.

The major sign of chronic osteomyelitis is a flare-up or reopening of an abscessed wound, with periodic pain and discharge of pus. X-rays show irregular bone and pieces of dead bone. Treatment for chronic osteomyelitis may require several operations to remove all the infected bone and other tissue, completely draining the abscess and repairing the bone when possible.

Questions to Ask Your Doctor

Are tests need to confirm the diagnosis?

What caused the osteomyelitis?

How serious is it?

What treatment will you be recommending? How effective is it?

What medications will you be prescribing and what are the side effects?

Will surgical drainage be required?

What are the chances that complications could develop?