Osteomyelitis (bone Infection)

Definition

Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs.

In children, osteomyelitis most commonly affects the long bones of the legs and upper arm, while adults are more likely to develop osteomyelitis in the bones that make up the spine (vertebrae). People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Once considered an incurable condition, osteomyelitis can be successfully treated today. Most people require surgery to remove parts of the bone that have died — followed by strong antibiotics, often delivered intravenously, typically for at least six weeks.

Symptoms

Signs and symptoms of osteomyelitis include:

• Fever or chills
• Irritability or lethargy in young children
• Pain in the area of the infection
• Swelling, warmth and redness over the area of the infection

Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems.

When to see a doctor. See your doctor if you experience worsening bone pain along with fever. If you're at risk of infection because of a medical condition or recent surgery or injury, see your doctor right away if you notice signs and symptoms of an infection.

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

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

• Via the bloodstream. Germs in other parts of your body — for example, from pneumonia or a urinary tract infection — can travel through your bloodstream to a weakened spot in a bone. In children, osteomyelitis most commonly occurs in the softer areas, called growth plates, at either end of the long bones of the arms and legs.
• From a nearby infection. Severe puncture wounds can carry germs deep inside your body. If such an injury becomes infected, the germs can spread into a nearby bone.
• Direct contamination. This may occur if you have broken a bone so severely that part of it is sticking out through your skin. Direct contamination can also occur during surgeries to replace joints or repair fractures.

Risk Factors

Your bones are normally resistant to infection. For osteomyelitis to occur, a situation that makes your bones vulnerable must be present.

Recent injury or orthopedic surgery A severe bone fracture or a deep puncture wound gives infections a route to enter your bone or nearby tissue. Surgery to repair broken bones or replace worn joints also can accidentally open a path for germs to enter a bone. Deep animal bites also can provide a pathway for infection.

Circulation disorders When blood vessels are damaged or blocked, your body has trouble distributing the infection-fighting cells needed to keep a small infection from growing larger. What begins as a small cut can progress to a deep ulcer that may expose deep tissue and bone to infection. Diseases that impair blood circulation include:

• Poorly controlled diabetes
• Peripheral arterial disease, often related to smoking
• Sickle cell disease

Problems requiring intravenous lines or cathetersThere are a number of conditions that require the use of medical tubing to connect the outside world with your internal organs. However, this tubing can also serve as a way for germs to get into your body, increasing your risk of an infection in general, which can lead to osteomyelitis. Examples of when this type of tubing might be used include:

• Dialysis machines
• Urinary catheters
• Long-term intravenous tubing, sometimes called central lines

Conditions that impair the immune systemIf your immune system is affected by a medical condition or medication, you have a greater risk of osteomyelitis. Factors that may suppress your immune system include:

• Chemotherapy
• Poorly controlled diabetes
• Having had an organ transplant
• Needing to take corticosteroids or drugs called tumor necrosis factor (TNF) inhibitors.

For unclear reasons, people with HIV/AIDS don't seem to have an increased risk of osteomyelitis.

Illicit drugs People who inject illicit drugs are more likely to develop osteomyelitis because they typically use nonsterile needles and don't sterilize their skin before injections.

Complications

Osteomyelitis complications may include:

• Bone death (osteonecrosis). An infection in your bone can impede blood circulation within the bone, leading to bone death. Your bone can heal after surgery to remove small sections of dead bone. If a large section of your bone has died, however, you may need to have that limb amputated to prevent spread of the infection.
• Septic arthritis. In some cases, infection within bones can spread into a nearby joint.
• Impaired growth. In children, the most common location for osteomyelitis is in the softer areas, called growth plates, at either end of the long bones of the arms and legs. Normal growth may be interrupted in infected bones.
• 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.

Preparing for your Podiatry Appointment

While you might initially bring your signs and symptoms to the attention of your family doctor, he or she may refer you to a doctor specializing in infectious diseases or to an Podiatric surgeon.

Here's some information to help you get ready for your appointment, and what to expect from your Podiatrist, Dr. Raymond A. DiPretoro, Jr..

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins or supplements that you're taking.
• Write down questions to ask your doctor.

For osteomyelitis, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• What treatments are available, and which do you recommend?
• Will surgery be necessary?
• What types of side effects can I expect from treatment?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your Podiatrist

During the physical exam, Dr. Raymond A. DiPretoro, Jr. may feel the area around the affected bone for any tenderness, swelling or warmth. If you have a foot ulcer, Dr. DiPretoro may use a dull probe to determine the proximity of the underlying bone.

Your doctor is likely to ask you a number of questions, such as:

• When did you first begin experiencing symptoms?
• Do you have a fever or chills?
• Does anything make your symptoms better or worse?
• Have you had any cuts, scrapes or other injuries lately?
• Have you had any surgery recently?
• Have you ever had a joint replaced? Or have you had surgical correction of a broken bone?
• Do you have diabetes? Do you have any foot ulcers?