OSTEOMYELITIS

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Orthopaedics

ABOUT THE DISEASE

Osteomyelitis is an infection of the bone caused due to bacteria or other germs. It affects about 2 out of every 10000 people. In children the long bones of the arms or legs are most often involved. In adults, the feet, spine bones (vertebrae), and hips (pelvis) are most commonly affected.

CAUSES

Bone infection is most often caused by bacteria. But it can also be caused by fungi or other germs. Infections can reach a bone by travelling through the bloodstream or spreading from nearby tissue such as in the case of pneumonia or a urinary tract infection that has spread to the bone through the blood (bacteremia, sepsis).

Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs. People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers. The infection can also start after bone surgery. This is more likely if the surgery is done after an injury or if metal rods or plates are placed in the bone.

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

SYMPTOMS

The symptoms can include:

• Pain and Swelling in the infected area
• Fever
• Nausea, General discomfort, uneasiness, or ill feeling due to infection
• Drainage of pus through the skin
• Excessive sweating
• Chills
• Lower back pain (if the spine is involved)
• Swelling of the ankles, feet, and legs
• Changes in gait (walking pattern that is a painful, yielding a limp)

DIAGNOSIS

- Physical examination: soft tissue swelling, bone tenderness, redness in the affected area.
- Blood tests: to confirm an infection: CBC (complete blood count), ESR (erythrocyte sedimentation rate); and/or CRP (C-reactive protein).
- Blood culture: to detect bacteria.
- Needle aspiration
- Biopsy
- Bone scan

TREATMENT METHODS

Options include:
- Medications-strong antibiotic are usually given IV for 4-6 weeks
- Surgery, like drainage of the affected area, removing parts of the bone that have died (debridement), removing foreign objects like plates or screws that may be present in the area or amputation.
- HBOT (Hyperbaric oxygen therapy) may be tried in chronic cases, to increase oxygenation and promote healing.