Osteomyelitis

What is osteomyelitis?

Osteomyelitis is an infection in a bone. The bones most often affected are the legs, arms, spine, and pelvis, but it can happen in any bone, especially after injury.

How does it occur?

Bacteria can infect bones in 2 ways:

• Most often bones are infected by bacteria through an open wound, during surgery, or from a bone fracture that broke through the skin.
• Bacteria from infections in other parts of the body may travel through the bloodstream and infect a bone. Some examples of infections that may spread to the bone are strep throat, skin infections, and tuberculosis.

Osteomyelitis may be acute or chronic. Acute infections happen quickly and get better with treatment. An infection may become chronic (long lasting) if antibiotics are not able to kill the bacteria or if you don’t carefully follow your treatment plan. You have a higher risk for chronic osteomyelitis if you:

• have the infection at the site of a recent injury
• have diabetes
• have sickle cell anemia
• are on dialysis
• have cancer of the skin or soft tissue under the skin
• abuse IV drugs.

What are the symptoms?

Symptoms include:

• pain in a bone
• redness, warmth, and swelling in the area around the bone
• swollen ankle, foot, or leg on the side of the infection
• tenderness of the bone
• limited movement if the infection is near a joint
• chills
• fever
• nausea
• general ill feeling
• sweating more than usual.

How is it diagnosed?

Your healthcare provider will ask about your medical history and symptoms. Your provider will examine you. He or she will check for bone tenderness, swelling, and redness.

Tests you may have are:

• blood tests
• X-rays or a CT scan to look for signs of infection and damage to the bone
• a bone scan to look for areas of infection

You may have a bone biopsy. After the area that may be infected is numbed with an anesthetic, a sample of bone will be taken from the area. The sample can then be checked for infection. It can also be tested to see what bacteria are causing the infection and which antibiotics will work best.

How is it treated?

Osteomyelitis is usually treated with antibiotics given into your veins (IV). Because it is hard to get the antibiotic into the bone, you may need to take antibiotics for several weeks or months.

You may need surgery to remove sections of bone that are infected or to drain an abscess. Damaged sections of bone usually grow back normally after the infection is under control.

If a large amount of infected or dead bone needs to be removed, you may need surgical procedures to strengthen the bone. When the infection is cleared you may need a bone graft. When you have a graft, healthy bone from somewhere else in your body is placed in the bone that was infected.

Before a bone graft can be done, you may need protection against fractures in the weakened bone. Rods or plates may be put into or alongside the bone to give strength to the bone while you finish antibiotic treatment. In most cases these stabilizers can be removed when healthy bone has replaced the infected bone.

If you have a chronic infection, you may need to take antibiotics off and on for the rest of your life.

How long will the effects last?

With prompt treatment, only about 5% of cases of acute osteomyelitis become chronic infections.

Chronic infections can cause general weakness, weight loss, anemia, kidney disease, and other disorders. Severe chronic osteomyelitis that does not get better with treatment may require removal of the infected part of the body (amputation). Without amputation the infection could spread to the blood and be fatal.

How can I take care of myself?

• Follow your healthcare provider's advice about how to take care of yourself. Your provider will tell you how you should use and care for the infected area. Your provider will let you know how active you should be, including when it’s OK to walk on an infected foot or leg.
• Keep all checkup appointments with your provider.
• Check with your provider before you take other medicines, including nonprescription products or other forms of treatment.
• Eat a healthy diet and get regular exercise as recommended by your provider.
• If you have a sore throat or fever, call your provider for advice. You may need immediate treatment.

How can I help prevent osteomyelitis?

• See your healthcare provider right away if you have signs of an infection anywhere in your body.
• Take care of any wounds or injuries right away, especially injuries with broken skin over a bone or joint.
• Get checked promptly if you have a wound that isn’t getting better with treatment.