Causes and Risks: Osteomyelitis is infection in the bones. Often, the original site of infection is elsewhere in the body, and spreads to the bone by the blood. The bone may be predisposed to infection due to recent trauma. In children, the long bones are usually affected.

In adults, the vertebrae and the pelvis are most commonly affected. Bacteria or fungus may be responsible for the infection. Pus is produced within the bone, which may result in a bone abscess. The abscess then deprives the bone of its blood supply.

Chronic osteomyelitis results when bone tissue dies as a result of the lost blood supply. Chronic infection can persist intermittently for years. Risk factors are recent trauma, diabetes, hemodialysis patients, and IV drug abuse. The incidence is 2 out of 10,000 people.

Prevention: Prompt and complete treatment of infections is helpful. High-risk people (those who are diabetic, have had their spleen removed, have had a recent trauma, etc.) should see a health care provider promptly if they have signs of an infection anywhere in the body.

Symptoms:

• Pain in the bone
• Local swelling, redness, and warmth
• Fever
• Nausea
• General discomfort, uneasiness, or ill feeling (malaise)
• Drainage of pus through the skin in chronic infection

• Sweating, excessive
• Chills
• Back pain, low
• Ankle, feet, and leg swelling

Signs and Tests: A physical examination shows bone tenderness, and possibly swelling and redness.

• A CBC shows elevated white blood cell count.
• The ESR is elevated.
• Blood cultures may help identify the causative organism.
• A needle aspiration of vertebral space for culture may be done.
• A bone lesion biopsy and culture may be positive for the organism.
• A skin lesion with a sinus tract (the lesion "tunnels" under the tissues) may yield drainage of pus for culture.

• Joints X-ray
• Hands X-ray
• Extremity X-ray
• Bone X-ray
• ALP (alkaline phosphatase) isoenzyme
• ALP

Treatment: OVERVIEW:
The objective of treatment is to eliminate the infection and prevent the development of chronic infection.

MEDICATIONS:
Intravenous antibiotics are started initially, and may later be changed depending on culture results. Some new antibiotics can be very effective when given orally.

SURGERY:
In chronic infection, surgical removal of dead bone tissue is indicated. The open space left by the removed bone tissue may be filled with bone graft, or by packing material to promote the growth of new bone tissue. Antibiotic therapy is continued for at least 3 weeks after surgery.

Infection of an orthopedic prosthesis may require surgical removal with debridement of the infected tissue surrounding the area. A new prosthesis may be implanted in the same operation, or delayed until the infection has resolved, depending on its severity.

Prognosis: The outcome is usually good with adequate treatment of acute osteomyelitis, and worse for chronic osteomyelitis, even with surgery. Resistant or complicated chronic osteomyelitis may result in amputation.

Complications:

• Chronic osteomyelitis
• Local spread of infection
• Reduced limb or joint function
• Amputation

Call your health care provider if you have symptoms of osteomyelitis, or if you have osteomyelitis and the symptoms persist despite treatment.