Osteomyelitis

Osteomyelitis [os-tee-oh-mahy-uh-LAHY-tis] is an infection of the bone. This type of bone infection usually appears in the tibia, femur, fibula, or other long bones.

Osteomyelitis occurs when the middle part of the bone, called the bone marrow, becomes infected. The bone marrow is soft tissue inside your bone that helps make the blood in your body.

Osteomyelitis can be treated with antibiotics (medicine to fight the infection) and sometimes surgery (to replace areas that have decayed due to infection, or to remove dead bone tissue).

Osteomyelitis can be:

• Acute. The infection has not been in the bone for very long, less than a few weeks.
• Chronic. The infection has been in the bone for weeks, months or years.

Chronic osteomyelitis is harder to treat and may do more damage than acute osteomyelitis, since the infection has had more time to damage the bone.

It can be hard to diagnose osteomyelitis in younger children or older people because they can be asymptomatic [ey-simp-tuh-MAT-ik], which means that there are no obvious symptoms or signs of the infection.

The symptoms of osteomyelitis can be different from person to person. Some groups, especially young children and older people, don’t have any symptoms at all until they’ve had the infection for a long time. For those who do show signs, common symptoms include:

• Pain in the bones
• Sweating
• Fever
• Chills
• Swelling
• Redness
• Warmth
• Pain
• Malaise (a general feeling of sickness or bad health)
• Incomplete healing (An area that was injured might get better and then start to hurt again)

These symptoms are common for many other conditions besides osteomyelitis. That makes it important to see your doctor if you have these symptoms so they can rule out other serious conditions and illnesses.

If you have any of the symptoms or signs of osteomyelitis, you should set up a time to see your doctor right away, because bone infections can get worse and harder to treat the longer they go on.

Osteomyelitis may be caused by:

• Bacteria or fungi that spread to the bone from surrounding tissues
• An infection in another area of the body that gets into the bone by moving through the blood
• Injuries where both the surface of the skin and the surface of the bone are broken (like fractures), and germs enter the area from outside the body
• Bone surgery where rods or plates are put into the bone

Osteomyelitis may occur with other risk factors, including:

• Early birth or other problems with delivery in newborn babies
• Diabetes
• Injuries that expose the bone, or other injuries that lead to infections which spread to the bone
• Sickle cell disease, a type of blood disorder
• Bites from either humans or animals
• A weak immune system, or any condition that causes a weak immune system
• Joint replacement surgery

Osteomyelitis can be diagnosed with different kinds of assessments or tests, including:

• Physical Exam. The doctor will look over the infected area to check for physical signs of osteomyelitis, like redness or swelling.
• Medical history. The doctor will ask about any other conditions or injuries you may have, to see if they could have caused the bone infection.
• Blood Cultures. A test in which a sample of your blood will be checked for bacteria and germs that may be causing the infection.
• Biopsy. A small piece of your bone, or bone marrow, will be taken out and sent to a lab to check for signs of infection.
• Scans of the bone.
• X-ray images of the bone. Electromagnetic rays let the doctor see what’s going on under your skin. These images may help the doctor know if you have osteomyelitis.
• MRI (magnetic resonance imaging) of the bone. Another kind of imaging test that uses magnets to look at your bones. There is no radiation in an MRI, as there is with an x-ray.
• Needle aspiration. A process where a needle is used to take a sample out of your bones to look for an osteomyelitis infection.

Osteomyelitis treatment is aimed at stopping the infection from damaging your bone and the surrounding muscles and tissues.

Antibiotics and surgery are the two major treatments used to heal osteomyelitis.

Antibiotics

Antibiotics are given to kill the germs causing the infection.

• Your doctor may give you several kinds of medicine at once that work together to fight the infection in their bones.
• Antibiotics may be given to you through an IV (a needle placed in your vein) or by mouth.

Surgery

Surgery may also be used if other treatment methods, like antibiotics, don’t help you get better on your own.

If you have had osteomyelitis for some time, and dead bone tissue has built up, surgery may be recommended to remove it.

Surgery may also be done to take out plates and screws that might be near the area of the infection.

Osteomyelitis can also result in areas of bone that need to be filled with material to help the bone grow back. Surgery can be done to place a bone graft in the gaps where the bone has worn down.

Pain Management

To manage the pain from osteomyelitis, or after osteomyelitis surgery, your doctor may give you pain medication.

Non-steroidal anti-inflammatory drugs (NSAIDs) are best for treating mild or moderate pain. Most of these medications are available over the counter, and include:

• Acetaminophen [uh-see-tuh-MIN-uh-fuhn] (Tylenol)
• Aspirin
• Ibuprofen [ahy-byoo-PROH-fuhn] (Advil, Motrin)
• Naproxen [nuh-PROK-suhn] (Aleve)

Opioids are much stronger medications that treat moderate to severe pain. They can only be taken if your doctor gives you a prescription. Opioids include:

• Codeine [KOH-deen]
• Fentanyl [FEN-tuh-nil]
• Morphine [MAWR-feen]
• Oxycodone [ok-see-KOH-dohn]

Opioids come with some common side effects, including:

• Constipation
• Nausea
• Dry mouth
• Drowsiness

Other medications used for pain management include anticonvulsants or antidepressants to help with nerve pain or steroids for pain with swelling.

You can take steps to prevent osteomyelitis by practicing good hygiene if you are hurt. Be sure to clean and bandage any wounds you have as soon as possible, so that germs and bacteria don’t have a chance to cause an infection.

Seek medical attention right away if you have a serious injury like an open fracture, which is a kind of fracture where the bone breaks through the skin. Your doctor will clean the wound and treat both the fracture and the risk of infection.

Osteomyelitis is an infection of the inner bone, called the marrow. This infection usually happens in the long bones, like the femur or tibia in your legs. Osteomyelitis can be either acute, meaning it hasn’t been in the bone for very long, or chronic, meaning you’ve had the infection for a long time.