Osteomyelitis: Symptoms, causes, and treatment

Osteomyelitis is an infection and inflammation of the bone or the bone marrow. It can happen if a bacterial or fungal infection enters the bone tissue from the bloodstream, due to injury or surgery.

Around 80 percent of cases develop because of an open wound. Symptoms include deep pain and muscle spasms in the inflammation area, and fever.

Bone infections commonly affect the long bones in the leg and upper arm, the spine, and the pelvis. In the past, it was difficult to treat osteomyelitis, but now, aggressive treatment can often save the infected bone and stem the spread of infection.

Osteomyelitis is estimated to affect 2 out of every 10,000 people in the United States at some time. In this article, we explain the treatment, symptoms, causes, and more.

Treatment

Treatment depends on the type of osteomyelitis.

Acute osteomyelitis

In acute osteomyelitis, infection develops within 2 weeks of an injury, initial infection, or the start of an underlying disease. The pain can be intense, and the condition can be life-threatening.

A course of antibiotics or antifungal medicine is normally effective. For adults, this is usually a 4- to 6-week course of intravenous, or sometimes oral, antibiotics or antifungals. Some patients need treatment in hospital, while others may receive injections as an outpatient, or at home if they can inject themselves.

Possible side effects from antibiotics include diarrhea, vomiting, and nausea. Sometimes there may be an allergic reaction.

If the infection is caused by MRSA or some other drug-resistant bacteria, the patient may need a longer course of treatment and a combination of different medications.

In some cases, hyperbaric oxygen therapy (HBOT) may be recommended.

Sub-acute osteomyelitis

In sub-acute osteomyelitis, infection develops within 1–2 months of an injury, initial infection, or the start of an underlying disease.

Treatment depends on severity, and whether there is any bone damage.

If there is no bone damage, treatment is similar to that used in acute osteomyelitis, but If there is bone damage, treatment will be similar to that used in chronic osteomyelitis.

Chronic osteomyelitis

In chronic osteomyelitis, infection starts at least 2 months after an injury, initial infection, or the start of an underlying disease.

Patients usually need both antibiotics and surgery to repair any bone damage.

Surgery can involve:

Draining: The area around the infected bone may need opening up for the surgeon to drain any pus or fluid that has built up in response to the infection.

Debridement: The surgeon removes as much diseased bone as possible, and takes a small margin of healthy bone to ensure that all the infected areas are removed. Any surrounding tissue with signs of infection may also need removing.

Restoring blood flow to the bone: Any empty space left by debridement may have to be filled with a piece of bone tissue, or skin or muscle from another part of the body. Temporary fillers can be used until the patient is healthy enough for a bone or tissue graft. The graft helps the body repair damaged blood vessels, and it will form new bone.

Removal of foreign objects: If necessary, foreign objects placed during previous surgery may be removed, such as surgical plates or screws.

Stabilizing the affected bone: Metal plates, rods, or screws may be inserted into the bone to stabilize the affected bone and the new graft. This may be done later. Occasionally external fixators are used to stabilize the affected bone.

If the patient cannot tolerate surgery, for example, because of illness, the doctor may use antibiotics for longer, possibly years, to suppress the infection. If the infection continues regardless, it may be necessary to amputate all or part of the infected limb.

Signs and symptoms

[red swollen knee]
Pain, redness, and swelling can be a sign of a bone infection.

The signs and symptoms of osteomyelitis depend on the type.

They commonly include:

Pain, which can be severe, and swelling, redness, and tenderness in the affected area

Irritability, lethargy, or fatigue

Fever, chills, and sweating

Drainage from an open wound near the infection site or through the skin

Other symptoms may include swelling of the ankles, feet, and legs, and changes in walking pattern, for example, a limp.

The symptoms of chronic osteomyelitis are not always not obvious, or they could resemble the symptoms of an injury.

This can make accurate diagnosis more difficult, especially in the hip, pelvis, or spine.

Osteomyelitis in children and adults

In children, osteomyelitis tends to be acute, and it usually appears within 2 weeks of a pre-existing blood infection. This is known as hematogenous osteomyelitis, and it is normally due to methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA).

Diagnosis can be difficult, but it is important to get a diagnosis as soon as possible, because delaying diagnosis can lead to growth disturbances or deformity. It can be fatal.

In adults, sub-acute or chronic osteomyelitis are more common, especially after an injury or trauma, such as a fractured bone. This is known as contiguous osteomyelitis. It usually affects adults over the age of 50 years.

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Causes

Osteomyelitis can occur when a bacterial or fungal infection develops within a bone or reaches the bone from another part of the body.

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