Osteomyelitis
Osteomyelitis is an infection of the bone. It can be caused by a variety of microbial agents and situations including:
- An open injury to the bone, such as an open fracture with the bone ends piercing the skin.
- An infection from elsewhere in the body, such as a urinary tract infection that has spread to the bone through the blood.
- A minor trauma, which can lead to a blood clot around the bone and then a secondary infection from seeding of bacteria.
- Bacteria in the bloodstream, which is deposited in a focal (localized) area of the bone. This bacterial site in the bone then grows, resulting in destruction of the bone. However, new bone often forms around the site.
- A chronic open wound or soft tissue infection can eventually extend down to the bone surface, leading to a secondary bone infection.
Osteomyelitis can affect both adults and children. The bacteria or fungus that can cause osteomyelitis, however, differs among age groups. In adults, osteomyelitis often affects the vertebrae and the pelvis. In children, osteomyelitis usually affects the adjacent ends of long bones. Long bones are large, dense bones that provide strength, structure, and mobility. They include the femur and tibia in the legs and the humerus and radius in the arms.
Osteomyelitis does not occur more commonly in a particular race or gender. However, some people are more at risk for developing the disease, including:
- People with diabetes
- Patients receiving hemodialysis
- People with weakened immune systems
- People with sickle cell disease
- Intravenous drug abusers
- The elderly
The symptoms of osteomyelitis can include:
- Pain and/or tenderness in the infected area
- Swelling and warmth in the infected area
- Fever
- Nausea, secondarily from being ill with infection
- General discomfort, uneasiness, or ill feeling
- Drainage of pus through the skin
Additional symptoms that may be associated with this disease include:
- Excessive sweating
- Chills
- Lower back pain
- Swelling of the ankles, feet, and legs
- Changes in gait (walking pattern that is a painful, yielding a limp)
Treating and managing osteomyelitis
The objective of treating osteomyelitis is to eliminate the infection and prevent the development of chronic infection. Chronic osteomyelitis can lead to permanent deformity and chronic problems, so it is important to treat the disease as soon as possible.
Drainage: If there is an open wound or abscess, it may be drained through a procedure called needle aspiration. In this procedure, a needle is inserted into the infected area and the fluid is withdrawn. Deep aspiration is preferred over often-unreliable surface swabs.
Medications: Prescribing antibiotics is the first step in treating osteomyelitis. Antibiotics help the body get rid of bacteria in the bloodstream that may otherwise re-infect the bone. The dosage and type of antibiotic prescribed depends on the type of bacteria present and the extent of infection. While antibiotics are often given intravenously, some are also very effective when given in an oral dosage. It is important to first identify the offending organism through blood cultures, aspiration, and biopsy so that the organism is not masked by an initial inappropriate dose of antibiotics.
Splinting or cast immobilization: This may be necessary to immobilize the affected bone and nearby joints in order to avoid further trauma and to help the area heal adequately and as quickly as possible. Splinting and cast immobilization are frequently done in children, although motion of joints after initial control is important to prevent stiffness and atrophy.
Surgery: Most well-established bone infections are managed through open surgical procedures during which the destroyed bone is scraped out. In the case of spinal abscesses, surgery is not performed unless there is compression of the spinal cord or nerve roots. Instead, patients with spinal osteomyelitis are given intravenous antibiotics. After surgery, antibiotics against the specific bacteria involved in the infection are then intensively administered during the hospital stay and for many weeks afterward.
With proper treatment, the outcome is usually good for osteomyelitis, although results tend to be worse for chronic osteomyelitis, even with surgery. Some cases of chronic osteomyelitis can be so resistant to treatment that amputation may be required; however, this is rare. Also, over many years, chronic infectious draining sites can evolve into a squamous-cell type of skin cancer, although this, too, is rare. Any change in the nature of the chronic drainage, or change of the nature of the chronic drainage site, should be evaluated by a physician experienced in treating chronic bone infections. Because it is important that osteomyelitis receives prompt medical attention, people who are at a higher risk of developing osteomyelitis should called their doctors as soon as possible if any symptoms arise.
Informations obtained from National Institute of Health.