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Osteomyelitis

Definition


Disease: Osteomyelitis Osteomyelitis
Category: Bones, joints, muscles diseases

Disease Definition:

Infection in a bone is called osteomyelitis. By traveling through the bloodstream or spreading from nearby tissue, infections can reach a bone. Additionally, when trauma exposes the bone to germs infections could start in the bone itself. The long bones of the body, such as the leg bones and upper arm bone in addition to the spine and pelvis are the most commonly affected bones with infections.
While osteomyelitis occurs as either the acute or chronic form in adults, but it usually occurs as an acute condition in children. In the past, there was no cure for osteomyelitis, but it can be successfully treated today. Yet, this disease is a serious condition, requiring aggressive treatment to save the affected bone and keep the infection from spreading.
 

Work Group:


Symptoms, Causes

Symptoms:

Depending on whether the condition is acute, lingering several months or less; or chronic, lingering for many months to years, signs and symptoms of osteomyelitis vary.
Acute osteomyelitis may cause some of these signs and symptoms:

 

  • Pain in the area of the infection
  • Swelling, warmth and redness over the area of the infection
  • Fever that might be sudden
  • Irritability or lethargy in young children

 

Chronic osteomyelitis may cause some of these Signs and symptoms:

 

  • Chronic fatigue
  • In some cases, fever
  • Warmth, swelling and redness over the area of the infection
  • Pain or tenderness in the affected area
  • Drainage from an open wound near the area of the infection

 

In some cases, osteomyelitis may cause no signs and symptoms or it may cause signs and symptoms that are hard to differentiate from other problems. For example, osteomyelitis of the spine, pelvis or hip might cause few signs and symptoms. Osteomyelitis that occurs after a broken bone (fracture) or deep wound may result in pain and swelling that the patient might attribute to their injury, not an infection.
 

Causes:

When an infection develops in a bone or spreads to a bone from another area of the body, osteomyelitis occurs. Bacteria or fungi are the cause. In reaction to the infection, the infected bone might deteriorate and form a pocket (abscess) of pus, which may obstruct blood supply to the bone. The loss of blood supply might contribute to death of the bone in cases of chronic osteomyelitis that last for years. The bones are naturally resistant to infection. A condition that makes the bones vulnerable must be present for osteomyelitis to develop. For example, trauma to the bone, as is the case in fracture, or the soft tissue around the bone, as in puncture wound, gives infections a route to enter the bone or nearby tissue. In case someone has a condition that weakens the body’s ability to fight infection, like sickle cell anemia, HIV or diabetes, he/she will be more vulnerable to infections.

 

Depending on where an infection starts and where it takes place, osteomyelitis is divided into various forms:

Infections that travel through the bloodstream: 

The majority of children develop osteomyelitis due to infections that travel trough the bloodstream (hematogenous osteomyelitis), while only a small part of the adults are affected by it. Infections might start as mild infections elsewhere in the body, like an upper respiratory tract infecton or urinary tract infection, and spread through the blood to a bone.

Infections that occur after injury or surgery:

Post-traumatic osteomyelitis is when bone infections occur after trauma, like open wounds to the surrounding skin and muscles, or broken bones breaking the skin (compound fracture). Additionally, if metal pins, screws or plates are used to secure the broken bones, post-traumatic osteomyelitis could occur after surgery. Bacteria could enter the bone or nearby tissue directly from open wounds.

Infections in people with poor circulation: 

In people with poor circulation, minor scrapes or cuts on the feet may develop into osteomyelitis. The body’s response to infection is impaired by poor circulation (vascular insufficiency). A deep ulcer that might expose deep tissue and bone to infection might start out as a small cut.

Infection in the bones of the spine: 

Usually affecting older adults, osteomyelitis that occurs in the spine (vertebral osteomyelitis) most commonly begins with an infection in the bloodstream, although it could also result from trauma or surgery (post-traumatic osteomyelitis). Some infections could result in vertebral osteomyelitis, such as:

 

  • Skin infections
  • Urinary tract infections
  • Respiratory tract infections
  • Infections in the mouth
  • Infections in areas where the patient receives medication injections
  • Infections in the inner lining of the heart (endocarditis).

 

Men are more likely to be affected by osteomyelitis than are women. Even though the acute type tends to be more common in children, and people older than 50 are more likely to have the spinal form of the infection, but this condition can develop at any age.

 

A high risk of osteomyelitis could be involved when someone has:

An increased risk of infections: 

Certain conditions allow germs more opportunities to access the body, increasing the risk of infection that contributes to osteomyelitis. Some examples are people using urinary catheters, people who illegally inject drugs, people who have had tubes placed in their bodies to give doctors easier access to major veins (central lines) and people on dialysis.

A recent injury: 

The risk of osteomyelitis is higher in the case of a deep puncture wound or a broken bone that breaks the skin exposing the body to germs that could result in infection. The patient should carefully follow their doctor’s instructions on taking antibiotics and taking precautions to avoid infection.

Poor circulation: 

When the arteries are damaged or blocked, the body has difficulty distributing the infection-fighting cells required to keep a small infection from growing larger. People with diabetes, peripheral arterial disease and sickle cell disease are considered to have poor circulation.

Orthopedic surgery:

Someone’s risk of infection could increase due to surgery to repair broken bones or replace worn joints. To avoid getting infected after surgery, the patient should follow the surgeon’s instructions.
 

Complications

Complications:

The infection resulting in osteomyelitis could often be managed, but there will always be a chance of recurrence. Chronic osteomyelitis is when the condition comes back or continues undetected for years. Chronic osteomyelitis could contribute to death of bone tissue and the collapse of the bone. Drastic treatment might be required to prevent infection from spreading to other portions of the body in the cases of osteomyelitis that couldn’t be managed. Drastic treatment might mean amputation of the affected limb if this condition occurs in arms and legs.
 

Treatments:

Chronic osteomyelitis is treated with surgery and antibiotics. In the case of acute osteomyelitis in children or vertebral osteomyelitis, surgery may not always be necessary.

 

SURGERY:

Depending on what bone is infected, the type of surgery could be determined for osteomyelitis. Surgery might include one or more of the following operations:

Surgery to drain the infected area: 

Any pus or fluid that has accumulated in response to the infection could be drained by opening up the area around the infected bone.

Surgery to restore blood flow to the bone: 

Skin or muscle from another portion of the body could be used to fill any empty space left by the debridement operation, with the use of a piece of bone or other tissue. In some cases, until the patient is healthy enough to undergo a bone graft or tissue graft, temporary fillers are placed in the pocket. The graft helps the body repair damaged blood vessels and form new bone.
Surgery to remove diseased bone and tissue: 
The surgeon removes as much of the affected bone as possible in a procedure called debridement, taking a small margin of healthy bone to make sure that all the infected areas have been removed. Additionally, surrounding tissue may also be removed if it shows signs of infection.

Surgery to remove any foreign objects: 

Sometimes, foreign objects, like surgical plates or screws placed throughout a previous surgery, might need to be removed.

 

The affected person might need to have metal plates, rods or screws inserted into the bone to stabilize the affected bone and the new graft. In some cases, this procedure is performed later. External fixators or other devices may also be used to stabilize the affected bone.

 

PEOPLE WHO CAN’T TOLERATE SURGERY:

Surgery as a way of treatment for osteomyelitis is not available to everybody. Extensive surgery and recovery may not be tolerable for people who are very ill. Doctors in these cases use antibiotics for longer periods of time, and sometimes even for years, in an attempt to suppress the infection, although cure in general isn’t possible with this approach. Amputation of all or part of an infected arm or leg might be necessary in case the infection persists.

 

ANTIBIOTICS:

When suspecting chronic osteomyelitis, the exact microorganism causing the infection preceding the antibiotics prescription should be determined. To determine the cause of the infection, the doctor uses a bone biopsy or a piece of bone removed during surgical treatment. The doctor will select the antibiotic most likely to be effective in fighting the patient’s specific form of infection after the bacterium or fungus resulting in the infection has been identified and the patient has undergone surgery. Although antibiotics could be taken orally, but they are usually administered through a vein in the arm (intravenously). Usually, the patient should take antibiotics for four to six weeks, or even longer. Sometimes, antibiotics might be needed to be taken for the rest of the patient’s life.
Nausea, diarrhea, allergic reactions and vomiting are some of the side effects that are caused by antibiotics.
 

Prognosis:

Not available

Expert's opinion

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