Osteomyelitis is an infection which most commonly occurs in young children & older patients, but all age groups are at risk. Two out of every 10,000 patients get osteomyelitis. It is also more likely to occur in patients with serious health issues. Osteomyelitis is a condition which causes inflammation of the bone. It is generally caused by an infecting organism. Although human bone is resistant to bacterial colonization, events such as surgery, trauma, presence of foreign bodies or the placement of artificial implants may disturb bone integrity & lead to the onset of bone infection.
What is Osteomyelitis?
Osteomyelitis is defined as an infection in bone. Infections can reach a bone by passing through the stream of blood or may spread from surrounding tissues. Infections can also commence in bone itself if an injury opens up the bone to germs. In children, osteomyelitis mostly affects long bones of upper arms & legs. Adults are more prone to develop osteomyelitis in bones that build up vertebrae. Patients who have diabetes can also get osteomyelitis in their feet. Once considered an inoperable condition, osteomyelitis now can be successfully managed today. Most patients need surgery to remove portions of bone that have deceased to be followed by staunch antibiotics, often given intravenously, usually for at least three to six weeks.
Most cases of osteomyelitis are caused due to a bacterium known as staphylococcus & which is usually found in nose or skin of even healthy people.
These germs can intrude bones in a number of ways, including the following.
- Bloodstream – In children, osteomyelitis mostly occurs in delicate areas known as growth plates, at either edge of long bones of legs or arms.
- Infected Prosthetic Joint or Infected Tissue – Severely deflated wounds can be responsible for carrying germs deep inside the patient’s body. If such an injury gets infected, germs can radiate into surrounding bone.
- Open Wounds – Germs may enter the patient’s body through a broken bone so intensely that portion of it may stick out of the skin. Direct contamination can also happen during surgeries to mend these joints or restore fractures.
Risk Factors Associated with Osteomyelitis
Bones are strong enough to resist any kind of infection. For osteomyelitis to occur there is a condition which makes bones sensitive must be present.
Serious bone fracture or an intense puncture wound gives infections a path to enter the patient’s bone or surrounding tissue. Surgery to restore impaired bones or replace depleted joints also can unexpectedly open a path for germs to enter bones. Implanted orthopedic hardware is a major risk factor for infection. Animal bites also can create a pathway for infection.
When blood vessels are blocked or damaged, the body has difficulty circulating infection-fighting cells which are required to keep small infections from advancing. What starts as a minor cut can head to a deep ulcer that may disclose deep tissue & bone to infections. Diseases that deteriorate blood circulation include the following.
- Sickle Cell Disease
- Poorly Controlled Diabetes
- Peripheral Arterial Disease
There are various conditions that need using a medical tubing to join the outside world with internal body organs. However, this tubing can also serve as a way for germs to reach deeper into patient’s body, enhancing chances of an infection in general, which can cause osteomyelitis. Following types of tubing are generally be used.
- Urinary catheters
- Dialysis machine tubing
- Long-term intravenous tubing, sometimes known as central lines
When patient’s immune system is affected by any medications or health conditions, they have a higher risk of osteomyelitis. Factors that may cease the immune system include the following.
- Poorly controlled diabetes
- Need to take drugs or corticosteroids called TNF (tumor necrosis factor) inhibitors
Patients who inject illicit drugs are more prone to osteomyelitis because they usually use non-sterile needles & do not sterilize their skin before taking injections.
Common signs & symptoms of osteomyelitis are enumerated below.
- Redness, tenderness & warmth in affected portion
- Loss of range of motion
- Swelling around affected bones
Osteomyelitis in vertebrae can be identified through severe back pain, especially at night.
Bone infections are categorized into the following types.
- Hematogenous Osteomyelitis – This type of osteomyelitis is most commonly found in children. Minor infections may develop anywhere in the body, such as urinary tract or upper respiratory tract & gradually spread through the bloodstream infecting bones.
- Post-Traumatic Osteomyelitis – These bone infections generally occur after trauma, such as compound fractures or an open wound near skin & muscle. According to health reports, this type of bone infections can also develop post-surgery, especially if screws, metal pins or plates are used to secure damaged bones.
- Vascular Deficiency – Patients with poor blood circulation may develop an infection from minor cuts or scrapes, mostly on feet.
Osteomyelitis can be diagnosed based upon physical evaluation & certain tests including imaging tests, blood tests & biopsy. Patients should consult respective surgeons if they are experiencing symptoms of osteomyelitis, such as bone pain & high temperature.
- Physical Assessment – Surgeons will first carry out physical evaluation of affected body organs to check for swelling, redness & tenderness. They may ask about any recent injuries, previous surgeries or infections. If condition of osteomyelitis is suspected, they may refer patients to a specialist in joints & bones diseases.
- Blood Tests – Surgeons may refer patients for a blood test. Blood test cannot, however, confirm osteomyelitis but can detect the number of white blood cells in patient’s blood, which may indicate a sign of severe infection.
- Imaging Tests – Following imaging tests are usually performed to detect bone damage caused by osteomyelitis.
- X-rays – X-ray tests are used to produce an image of the affected area of bone. This test may not be useful for diagnosis if the condition is in initial stages.
- Magnetic Resonance Imaging (MRI) Scan – Strong magnetic field & radio waves are used to create an image of the inner portion of the affected bone.
- Computerized Tomography (CT) Scan – Series of 3D images of the impaired bone are taken for identifying this condition.
- Ultrasound Scan – High-frequency sound waves are used to produce pictures of affected bone to highlight any deformities.
- Biopsy – When imaging tests suggest osteomyelitis, it becomes necessary to pull off a tiny sample of bone for further testing. This test is known as a biopsy. Biopsy can confirm presence of osteomyelitis & can aid establish the type of fungus or bacteria which is causing the infection.
While patients might initially bring experienced signs & symptoms to the attention of the family doctor, doctors may subsequently refer them to medical professionals specializing in infectious diseases or to an orthopedic surgeon. Following information might help patients to stay prepared for initial appointment & clearly understand what to expect from doctors.
- Pre-Appointment Limitations – When patients make an initial appointment, they should be sure to ask if there is anything that needs to be done in advance, such as restricting diet.
- List of Symptoms – Patients should write down any symptoms that they are experiencing, including any that may seem irrelevant to the purpose of this appointment.
- Medicines – Patients should make a list of all medications, health supplements or vitamins that they are taking.
Doctors are likely to ask various questions to patients during initial consultation.
- When did you start experiencing these symptoms?
- Do you have chills or fever?
- Have you undergone any surgery earlier?
- Does anything make your symptoms worse or better?
- Have you had any scrapes, cuts or other injuries lately?
- Have you had surgical corrections of any damaged bone?
Patients may wish to discuss some important aspects & concerns regarding the treatment of osteomyelitis with the doctor. Following list of queries may be helpful.
- What is osteomyelitis?
- What is the most likely cause of my symptoms?
- Are there other possible reasons which have caused these symptoms?
- What types of tests do I require?
- Do these tests need any special preparation?
- What treatments options are available & which do you suggest me?
- Will surgery be essential?
- What kind of side effects can I expect from the recommended treatment?
- Is there a generic alternative to the medications you are prescribing?
- Are there any printed materials or brochures that I can read?
- What websites do you suggest visiting?
Treatment Options for Osteomyelitis
Most common treatments for osteomyelitis are surgery to remove areas of bone that are deceased or infected, followed by antibiotics. Hospitalization is generally important.
Depending upon the seriousness of bone infection, osteomyelitis surgery may involve one or more of the following surgical procedures.
- Draining the Infected Area – Opening up the portion near the impaired bone allows surgeons to drain any fluid or pus that has assembled in response to bone infection.
- Removing Diseased Bone & Tissue – In a procedure known as, ‘debridement’, orthopedic surgeons remove as much of damaged bone as possible & take a little margin of sound bone to make sure that all the infected regions have been removed. Nearby tissues showing signs of infection also may be removed.
- Restoring Blood Flow – Respective orthopedic surgeons may fill any empty area left by debridement technique with a piece of bone or other tissue, such as muscle or skin, from different parts of patient’s body. Sometimes temporary fillers are planted until patients become healthy enough to undergo tissue graft or bone graft procedure. Graft helps the body repair ruptured blood vessels & form new bone.
- Removing Foreign Objects – In many cases, foreign objects like screws or surgical plates implanted during previous surgery may have to be taken off.
- Amputating the Limb – As last option, orthopedic surgeons may amputate the affected limb to halt infection from spreading further.
Bone biopsy test will reveal what kind of germ is causing infection, so the surgeon can decide an antibiotic that works efficiently for that infection. These antibiotics are mostly administered through veins in patient’s arm for at least three to six weeks. An additional series of oral antibiotics may also be required for more severe infections.
After surgery of osteomyelitis, patients should take care of any wounds or scrapes. They should thoroughly wash & clean any open wounds & cuts in skin. If cuts or wounds do not heal, patients should promptly report to doctors. In addition to this, patients should use appropriate footwear & protective equipment to avoid future injuries while running, jumping or participating in sports.
In a majority of cases, infection that caused osteomyelitis can be properly treated & controlled. However, there are chances of some complications after surgery of osteomyelitis.
- Recurring Chronic Osteomyelitis – Osteomyelitis that returns back even after treatment or remains undetected for years is known as chronic osteomyelitis. It can sometimes result in bone tissue death & collapsing of bone. Some underlying factors that cause such type of osteomyelitis are weakened immune system & poor blood circulation. For patients who have had a prior episode of chronic osteomyelitis, there is always a chance of recurrence.
- Amputation – Patients whose health is extremely poor may eventually need to have a leg, foot or arm amputated if infection spreads again after surgery.
Outcome may be worse for those with chronic osteomyelitis. Mainly, surgical outcomes for patients with bone infection depend upon the following factors.
- Patient’s health
- Type of infection
- Lifestyle of patients
With proper surgery & treatment, outcome for osteomyelitis is often rewarding.
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