Osteomyelitis

Osteomyelitis is an infection in a bone. It can affect one or more parts of a bone. Infections can reach a bone through the bloodstream or from nearby infected tissue. Infections also can begin in the bone if an injury opens the bone to germs.

People who smoke and people with chronic health conditions, such as diabetes or kidney failure, are at higher risk of getting osteomyelitis. People who have diabetes with foot ulcers may get osteomyelitis in the bones of their feet.

Most people with osteomyelitis need surgery to remove areas of the affected bone. After surgery, most often people need strong antibiotics given through a vein.

Symptoms of osteomyelitis may include:

• Swelling, warmth and tenderness over the area of the infection.
• Pain near the infection.
• Tiredness.
• Fever.

Sometimes osteomyelitis causes no symptoms. When it does cause symptoms, they can be like symptoms of other conditions. This may be especially true for infants, older adults and people who have weakened immune systems.

When to see a doctor

See your healthcare professional if you have a fever and bone pain that gets worse. People at risk of infection because of a medical condition or recent surgery or an injury should see a healthcare professional right away if they have symptoms of an infection.

Most often, staphylococcus bacteria cause osteomyelitis. These bacteria are germs that live on the skin or in the nose of all people.

Germs can enter a bone through:

• The bloodstream. Germs in other parts of your body can travel through the blood to a weak spot on a bone. For instance, germs can come from pneumonia in the lungs or a urinary tract infection in the bladder.
• Injuries. Puncture wounds can carry germs deep inside the body. If such an injury becomes infected, the germs can spread into a nearby bone. Germs also can enter the body from a broken bone that sticks out through the skin.
• Surgery. Germs can enter the body and travel to bones during surgeries to replace joints or fix broken bones.

Healthy bones resist infection. But bones are less able to resist infection as you get older. Besides wounds and surgery, other factors that can increase your risk of osteomyelitis may include:

• Conditions that weaken the immune system. This includes diabetes that isn't well-controlled.
• Peripheral artery disease. This is a condition in which narrowed arteries cut blood flow to the arms or legs.
• Sickle cell disease. This condition is passed through families, called inherited. Sickle cell disease affects the shape of red blood cells and slows blood flow.
• Dialysis and other procedures that use medical tubing. Dialysis uses tubes to remove waste from the body when the kidneys don't work well. The medical tubes can carry germs from outside the body inside.
• Pressure injuries. People who can't feel pressure or who stay in one position for too long can get sores on their skin where the pressure is. These sores are called pressure injuries. If a sore is there for a time, the bone under it can become infected.
• Illicit drugs by needles. People who take illicit drugs by needle are more likely to get osteomyelitis. This is true if they use needles that aren't sterile and if they don't clean the skin before using the needles.

Osteomyelitis complications may include:

• Bone death, also called osteonecrosis. An infection in your bone can block blood flow within the bone, leading to bone death. If you have areas where bone has died, you need surgery to remove the dead tissue for antibiotics to work.
• Septic arthritis. Infection within bones can spread into a nearby joint.
• Impaired growth. Osteomyelitis can affect the growth of bones in children. This is true if osteomyelitis is in the softer areas, called growth plates, at either end of the long bones of the arms and legs.
• Long-term osteomyelitis, called chronic osteomyelitis. Osteomyelitis that doesn't respond to treatment can become chronic osteomyelitis.

If you have an increased risk of infection, talk with your healthcare professional about ways to prevent infections. Cutting your risk of infection will cut your risk of osteomyelitis.

Take care not to get cuts, scrapes, and animal scratches or bites. These give germs a way to get into your body. If you or your child has a minor injury, clean the area right away. Put a clean bandage on it. Check wounds often for signs of infection.

Your healthcare professional may feel the area around the affected bone for tenderness, swelling or warmth. If you have a foot sore, your healthcare professional may use a dull probe to see how close the sore is to the bone under it.

You also might have tests to diagnose osteomyelitis and to find out which germ is causing the infection. Tests may include blood tests, imaging tests and a bone biopsy.

Blood tests

Blood tests can show high levels of white blood cells and other markers in the blood that may mean that your body is fighting an infection. Blood tests also may show which germs caused the infection.

No blood test can tell whether you have osteomyelitis. But blood tests can help your healthcare professional decide what other tests and procedures you may need.

Imaging tests

• X-rays. X-rays can show damage to a bone. But the damage may not show on X-rays until osteomyelitis has been there for weeks. You may need more-detailed imaging tests if your infection is more recent.
• MRI scan. Using radio waves and a strong magnetic field, MRI scans can make detailed images of bones and the soft tissues around them.
• CT scan. This scan combines X-ray images taken from many different angles to give views of internal structures of the body. You might have a CT scan if you can't have an MRI.
• Bone scan. This nuclear imaging test uses small amounts of radioactive substances, called radioactive tracers, a special camera that can detect the radioactivity and a computer. Cells and tissues that are infected take in the tracer so that the infection shows on the scan.

Bone biopsy

A bone biopsy can show what type of germ has infected your bone. Knowing the type of germ helps your healthcare professional choose an antibiotic that works well for the type of infection you have.

For an open biopsy, you're put to sleep with medicine called a general anesthetic. Then you have surgery to get to the bone to take a sample.

For a needle biopsy, a surgeon puts a long needle through your skin and into your bone to take a sample. This procedure uses medicine to numb the area where the needle is inserted. The medicine is called a local anesthetic. The surgeon may use an X-ray or other imaging scan to guide the needle.

Most often, treatment for osteomyelitis involves surgery to remove parts of the bone that are infected or dead. Then you get antibiotics through a vein, called intravenous antibiotics.

Surgery

Depending on how bad the infection is, osteomyelitis surgery may involve one or more of the following procedures:

• Drain the infected area. A surgeon opens the area around the infected bone to drain pus or fluid from the infection.
• Remove diseased bone and tissue. In a procedure called debridement, the surgeon removes as much of the diseased bone as possible. The surgeon also may remove a small amount of healthy bone and tissue around the diseased bone. This is a way to make sure to remove all the infection.

• Restore blood flow to the bone. The surgeon may fill any empty space the debridement procedure leaves with a piece of bone or other tissue. This might be skin or muscle from another part of the body.

  Sometimes the surgeon puts short-term fillers in the space until you're healthy enough to have a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new bone.

• Remove foreign objects. Sometimes, the surgeon needs to remove foreign objects. These may be surgical plates or screws placed during an earlier surgery.

Medications

Your healthcare professional chooses an antibiotic based on the germ causing the infection. You are likely to get the antibiotic through a vein in your arm for about six weeks. If your infection is more serious, you may then need to take antibiotics by mouth.

If you smoke, quitting smoking can help speed healing. You also need to manage any long-term conditions you have. For instance, control your blood sugar if you have diabetes.

You'll likely start by seeing your main healthcare professional. This person may send you to a doctor who specializes in infectious diseases or to an orthopedic surgeon.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they began. Be sure to include all symptoms, even if they don't seem to be linked to the reason you made the appointment.
• All medicines, vitamins or supplements that you take, including doses.
• Write down questions to ask your healthcare professional.

For osteomyelitis, some questions to ask include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• What treatments are there?
• Do I need surgery?
• I have other health conditions. How can I best manage these conditions together?
• Are there any brochures or other printed material I can have? What websites do you suggest?

What to expect from your doctor

Your healthcare professional is likely to ask questions, such as:

• 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 had a joint replaced? Or have you had a broken bone that you had surgery to fix?
• Do you have diabetes? Do you have any foot ulcers?