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Osteomyelitis

osteomyelitis


Osteomyelitis is an infection of a bone. Many different types of bacteria can cause osteomyelitis. However, infection with a bacterium called Staphylococcus aureus is the most common cause. Infection with a fungus is a rare cause.

How do you get osteomyelitis?

  • Via the bloodstream. This is the common cause in children.
  • Following an injury. In particular, if you have a broken bone which you can see through the cut skin.

Who is at risk of developing osteomyelitis?

  • Have recently fractured (broken) a bone.
  • Have a bone prosthesis.
  • Have recently had surgery to a bone.
  • Have a poor immune system.
  • Inject street drugs which can be contaminated with bacteria.
  • Are dependent on alcohol.
  • Have had a previous episode of osteomyelitis.
  • Have certain types of blood disorders. For example, sickle cell disease.
  • Have reduced skin sensation.
  • Have regular kidney dialysis.
  • Take steroids regularly.

Which bones can be affected?

The long bones of the leg (femur, tibia and fibula) are the most commonly affected. However, osteomyelitis can affect any bone (although it is very rare in some bones).

What are the symptoms of osteomyelitis?

  • Pain and tenderness.
  • A lump may develop over a bone, which is usually very tender.
  • Redness of overlying skin may then develop.
  • Feeling generally unwell with fever.

If osteomyelitis develops following a fracture to a bone then the symptoms include increasing redness, swelling, and pain around the fracture site. Pus may come out from a skin wound over a fracture.

Tests to confirm the diagnosis

A plain X-ray is not useful in the early stages of osteomyelitis as an X-ray can be normal for up to a week or so after the infection starts.

Tests to find which bacterium is causing the infection

  • The blood often contains some bacteria from the bone infection. Samples of blood are sent to the 'lab' to identify which type of bacterium is causing the infection.
  • Any discharging pus can be sent for culture.
  • Fluid drawn off from an infected joint can also be analyzed.

What is the outlook (prognosis)?

If the infection is treated promptly, there is a good chance of a complete cure. The best outcome occurs if you get treatment within 3-5 days of the start of infection.
If the infection is left untreated, an abscess (ball of pus) may develop in the bone and surrounding tissue. In time, this may burst on to the skin and leave a track.

  • Blood infection which can cause serious illness.
  • Nonunion of fracture.
  • Compression of other structures next to the infection.

What is the treatment for osteomyelitis?

  • Antibiotics
  • Surgery

You will usually need an operation if:

  • An abscess develops.
  • The infection presses on other important structures.
  • The infection has become chronic (persistent) and some bone has been destroyed.
  • Rarely, amputation of a foot or leg is needed if infection persists in a leg bone and does not clear with any other treatment.

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