Osteomyelitis

Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs. It is an inflammatory process involving the bone and its structures caused by pyogenic organisms that spread through the bloodstream, fractures, or surgery.

Smokers and people with chronic health conditions, such as diabetes or kidney failure, are more at risk of developing osteomyelitis. People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Although once considered incurable, osteomyelitis can now be successfully treated by the Orthopedic Surgeon practicing at Shreya Hospital, Ghaziabad. Most people need surgery to remove areas of the bone that have died. After surgery, strong intravenous antibiotics are typically needed.

Signs and symptoms of osteomyelitis include:

• Fever
• Swelling, warmth and redness over the area of the infection
• Pain in the area of the infection
• Fatigue

Causes

Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals.

Germs can enter a bone in a variety of ways, including:

• The bloodstream. Germs in other parts of your body — for example, in the lungs from pneumonia or in the bladder from a urinary tract infection — can travel through your bloodstream to a weakened spot in a bone.
• Injuries. Severe puncture wounds can carry germs deep inside your body. If such an injury becomes infected, the germs can spread into a nearby bone. Germs can also enter the body if you have broken a bone so severely that part of it is sticking out through your skin.
• Surgery. Direct contamination with germs can occur during surgeries to replace joints or repair fractures.

Osteomyelitis complications may include:

• Bone death (osteonecrosis). An infection in your bone can impede blood circulation within the bone, leading to bone death. Areas where bone has died need to be surgically removed for antibiotics to be effective.
• Septic arthritis. Sometimes, infection within bones can spread into a nearby joint.
• Impaired growth. Normal growth in bones or joints in children may be affected if osteomyelitis occurs in the softer areas, called growth plates, at either end of the long bones of the arms and legs.
• Skin cancer. If your osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer.

Diagnosis of Osteomyelitis

Your doctor may feel the area around the affected bone for any tenderness, swelling or warmth. If you have a foot ulcer, your doctor may use a dull probe to determine the proximity of the underlying bone.

Your doctor may order a combination of tests and procedures to diagnose osteomyelitis and to determine which germ is causing the infection. Tests may include:

Blood tests

Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If osteomyelitis is caused by an infection in the blood, tests may reveal which germs are to blame.

No blood test can tell your doctor whether you do or don’t have osteomyelitis. However, blood tests can give clues to help your doctor decide what additional tests and procedures you may need.

Imaging tests

• X-rays. X-rays can reveal damage to your bone. However, damage may not be visible until osteomyelitis has been present for several weeks. More-detailed imaging tests may be necessary if your osteomyelitis has developed more recently.
• Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, MRI scans can produce exceptionally detailed images of bones and the soft tissues that surround them.
• Computerized tomography (CT). A CT scan combines X-ray images taken from many different angles, creating detailed cross-sectional views of a person’s internal structures. CT scans are usually done only if someone can’t have an MRI.

Bone biopsy

A bone biopsy can reveal what type of germ has infected your bone. Knowing the type of germ allows your doctor to choose an antibiotic that works particularly well for that type of infection.

An open biopsy requires anesthesia and surgery to access the bone. In some situations, a surgeon inserts a long needle through your skin and into your bone to take a biopsy. This procedure requires local anesthetics to numb the area where the needle is inserted. X-ray or other imaging scans may be used for guidance.

Treatment of Osteomyelitis

The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.

Surgery

Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following procedures:

• Drain the infected area. Opening up the area around your infected bone allows your surgeon to drain any pus or fluid that has accumulated in response to the infection.
• Remove diseased bone and tissue. In a procedure called debridement, the surgeon removes as much of the diseased bone as possible and takes a small margin of healthy bone to ensure that all the infected areas have been removed. Surrounding tissue that shows signs of infection also may be removed.
• Restore blood flow to the bone. Your surgeon may fill any empty space left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your body.Sometimes temporary fillers are placed in the pocket until you’re healthy enough to undergo a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new bone.
• Remove any foreign objects. In some cases, foreign objects, such as surgical plates or screws placed during a previous surgery, may have to be removed.
• Amputate the limb. As a last resort, surgeons may amputate the affected limb to stop the infection from spreading further.

Medications

A bone biopsy will reveal what type of germ is causing your infection so your doctor can choose an antibiotic that works well against that type of infection. The antibiotics are usually administered through a vein in your arm for about six weeks. An additional course of oral antibiotics may be needed for more-serious infections.

If you smoke, quitting smoking can help speed healing. It’s also important to take steps to manage any chronic conditions you may have, such as keeping your blood sugar controlled if you have diabetes.