Osteomyelitis – Be Aware, Be Safe

Overview:

Osteomyelitis is an infection of the bone that requires prompt treatment to prevent adverse outcomes. The blog explains all there is to know about this condition.

An infection of the bone is called osteomyelitis. The condition is rare affecting only around 2 people out of 10,000, but it is painful and needs prompt treatment. The infection might originate in the bone itself (when an open injury exposes the bone to infection) or it can spread to the bone from other body parts. The infection can also reach the bone through the blood stream.

People with compromised immunity are more likely to get affected by osteomyelitis. This includes children, people with chronic conditions and smokers. Earlier, osteomyelitis was incurable but nowadays it can be treated, provided early treatment is sought. Severe cases may need surgery to remove the infected part of the bone.

Signs to Watch-out For

• Fever
• Tiredness
• Pain in the affected area
• Inflammation in the affected area
• Affected area is warm to touch

For children, elderly and immunocompromised individuals, the above signs may not be present or may be confused for other conditions.

Causes

Staphylococcus bacteria is the most common cause. Most of us have these bacteria on our skin and are not adversely affected by it. But as mentioned above, some people are more susceptible to it.

So, how exactly do germs reach the bone to cause osteomyelitis? There are a few ways by which this can happen.

• Injuries: Deep wounds can give germs direct access to bones. Trauma can leave bones exposed to germs and increase risk of osteomyelitis.
• Other Body Parts: When an infection is present in another part of the body (one example being pneumonia in the lungs), it can travel through the bloodstream and reach the bones.
• Surgical Procedures: Germs can enter the bone during surgeries.

Risk Factors

Bones are normally strong enough to withstand infection but this resistance decreases with age. Along with this, there are other factors which increase osteomyelitis risk.

• An orthopaedic procedure like a fracture fixation can inadvertently allow germ entry. Implants used during joint replacement surgeries too can be risk factors.
• Animal bites, injuries from sharp objects like nails that penetrate deep or any severe injury that leaves the bone exposed – all can increase the risk of osteomyelitis.
• Any circulatory disorder can affect a body part’s ability to heal due to reduced circulation. As a result, an insignificant wound can progress to something bigger and affect the bones. The circulation of blood can get affected due to various conditions like diabetes, peripheral artery disease, etc.
• In some cases, IV lines and catheters can also act as routes for the germs to reach bones. Dialysis tubing, IV central lines and urinary catheters can possibly act as risk factors for osteomyelitis.
• Any medical condition that compromises the body’s immune system (like cancer and badly controlled diabetes) can increase the risk of osteomyelitis.
• Drug addicts are at an increased risk because they usually use unsterilized needles to inject themselves.

Complications of Osteomyelitis

• Osteonecrosis, a condition in which the bone cells die without enough blood supply, can occur as a result of osteomyelitis. These dead cells will have to be removed surgically for the rest of the bone to heal.
• Septic arthritis results when the infection in the bone spreads to the joints.
• In children, when the growth plates are affected by osteomyelitis, it will result in growth impairment.
• Squamous cell cancer (of the skin around the injury) can result if there is discharge from the injury.

Prevention

• The best way to prevent osteomyelitis is by keeping wounds clean. Open wounds should be washed under running water for around 5 minutes and then wrapped in sterile bandage.
• If you suffer from any of the risk factors for osteomyelitis, you should talk to your doctor about the ways by which you can minimize the risk.
• Try to avoid animal bites and scratches.
• Watch any injury carefully for signs of infection.
• People with a diabetic condition should pay extra attention to foot injuries; a doctor consult is best if there is an injury.
• Sudden onset osteomyelitis is best treated early so do not delay getting professional help.

Diagnosis

A physical examination to check the affected area for warmth and swelling will be done. In case of an injury, the doctor will try to determine how close the injury is to the bone. Other than this, a few tests will be needed to confirm diagnosis.

• A blood test to determine WBC level. Elevated values indicate an infection.
• An x-ray might be advised to determine bone damage. However, x-rays will show changes only if the condition is in the advanced stages.
• An MRI can give a comprehensive result on bone health as well as health of surrounding tissue.
• A CT scan can be done if the patient cannot undergo MRI.
• A bone biopsy can reveal the exact germ that is causing the infection. With this knowledge, the doctor can choose the most effective antibiotic to treat the infection. A bone biopsy can be done under local anesthesia, wherein a thin, long needle is inserted to get bone cells. Alternatively, it can be performed as an open procedure under general anesthesia as well.

Treatment

The immediate aim would be to stop infection and prevent further spread. Antibiotics are the preferred treatment modality and are usually administered intravenously.

If antibiotics do not control the condition, surgery might be needed. The exact surgical procedure depends on the severity of the condition.

• The doctor may open up the affected area to drain any accumulated pus.
• A procedure called debridement may be done to remove the infected bone cells and soft tissue. The removed cells are replaced with tissues or bone cells from another body part.
• If a prosthetic is responsible for the infection, surgery will be done to remove it.

Conclusion                                                                                 

Remember, osteomyelitis is best treated early. A doctor consult is a must if:

• You experience any of the signs of osteomyelitis
• Have bone pain which gets worse at night time
• Are experiencing symptoms and have recently undergone surgery or have had an injury