...less medical jargon in a 'Quick Glance' format!
Osteomyelitisis the medical term for 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 trauma exposes the bone to germs. Bone infections most commonly affect the long bones of the body — usually the leg bones and upper arm bone. But it can occur in other bones, as well, including the bones of the spine, the foot bones, the pelvis and the collarbone.
Once considered a fatal condition, osteomyelitis can be successfully treated today with surgery and antibiotics. Still, it is a serious condition, requiring aggressive treatment to prevent spread of the infection and to save the affected bone, if possible.
This disease occurs more often in men than in women. People of any age can develop it, though it's most common in children and people older than 50.
This disease occurs in children most commonly as an acute condition — meaning that signs and symptoms last several months or less. In adults, it is most commonly a chronic condition, lasting several months to years. Whether osteomyelitis is acute or chronic determines the treatment, as children with acute an case may be treated with antibiotics alone. Adults with a chronic case usually require surgery in addition to antibiotics.
Symptoms:
Signs and symptoms in children typically worsen in a matter of days or weeks and include:
Fever that may be abrupt
Irritability
Lethargy
Pain in the area of the infection
Warmth over the area of the infection
Swelling and redness over the area of the infection
Signs and symptoms of chronic osteomyelitis in adults include:
Warmth, swelling and redness over the area of the infection
Pain or tenderness in the affected area
Drainage from an open wound near the area of the infection
Fever in some cases
Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish. For instance, osteomyelitis of the hip, spine or pelvis may have few signs and symptoms. Osteomyelitis that occurs after a broken bone or deep wound may cause pain and swelling that you may attribute to your injury, not an infection.
Causes:
This disease occurs when an infection develops in a bone or spreads to a bone from another area of the body. It is most often caused by bacteria or fungi. The infected bone may deteriorate and form a pocket of pus in response to the infection. This may block blood supply to the bone. In cases of chronic osteomyelitis that last for years, the loss of blood supply may lead to death of the bone.
Your bones are normally resistant to infection. In order for this disease to occur, a situation that makes your bones vulnerable must be present. For instance, trauma to your bone, such as a fracture, or to the soft tissue around your bone, such as a puncture wound, gives infections a route to enter your bone or nearby tissue. You may also be vulnerable to infection if you have a condition that weakens your body's ability to fight an infection.
Osteomyelitis is divided into several types depending on where an infection begins and where it occurs. Types include:
Infections that travel through the bloodstream.
Infections that travel through the bloodstream affect only a small portion of adults, but affect the majority of children with this disease. Infections may begin as mild infections elsewhere in the body, such as an upper respiratory tract infection or urinary tract infection, and spread through the blood to a bone.
Infections that occur after injury or surgery.
Bone infections can occur after trauma, such as broken bones that break the skin or open wounds to the surrounding skin and muscles. Post-traumatic osteomyelitis can also occur after surgery if metal pins, screws or plates are used to secure the broken bones. Open wounds offer easy access for bacteria to enter the bone or nearby tissue directly.
Infections in people with poor circulation.
Osteomyelitis that occurs in people with poor circulation, such as those with diabetes, usually begins with minor scrapes or cuts on the feet. Poor circulation impairs the body's response to infection. What begins as a small cut can progress to a deep ulcer that may expose deep tissue and bone to infection.
Infection in the bones of the spine.
When it occurs in the spine, it most commonly affects older adults and usually starts with an infection in the bloodstream, though it can also occur from trauma or surgery. A number of infections can cause vertebral osteomyelitis, including skin infections, respiratory tract infections, urinary tract infections, infections in the inner lining of the heart, infections in the mouth, and infections in areas where you receive injections of either prescribed medications or illegal drugs.
Treatment:
Doctors treat chronic cases with surgery and antibiotics. In acute instances in children, surgery isn't always necessary.
. . . Surgery
What type of surgery you undergo depends on what bone is infected. 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, taking 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 need to be removed.
In order to stabilize the affected bone and the new graft, you may need to have metal plates, rods or screws inserted into the bone. This procedure is sometimes performed later. Your doctor may use other devices to stabilize your affected bone, such as external fixators.
. . . People who can't tolerate surgery
Surgery for osteomyelitis isn't available to everyone. People who are very ill may not be able to endure the extensive surgery and recovery. In these cases, doctors may use antibiotics for longer periods of time, sometimes for years, in an attempt to suppress the infection, though cure generally isn't possible with this approach. If the infection persists, amputation of all or part of an infected arm or leg may be necessary.
. . . Antibiotics
If your doctor suspects you have chronic osteomyelitis, he or she works to determine exactly what microorganism is causing the infection before prescribing antibiotics. Your doctor uses a bone biopsy or a piece of bone removed during surgical treatment to determine what's causing the infection.
Once the bacterium or fungus causing your infection has been identified and you've undergone surgery, if necessary, your doctor selects the antibiotic most likely to be effective in fighting your particular type of infection. Antibiotics are administered most often through a vein in your arm or, in some cases, they can be taken orally. You typically take antibiotics for four to eight weeks. In some cases, you may need to take antibiotics for the rest of your life.
Antibiotics carry a risk of side effects, including nausea, vomiting and diarrhea. Allergic reactions also can occur. Talk to your doctor about the side effects to expect from your specific medication.
