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After Infection: Osteomyelitis, Bone Infection

Osteomyelitis is infection in the bone. Osteomyelitis can occur in infants, children, and adults. Different types of bacteria typically affect the different age groups. In children, osteomyelitis most commonly occurs at the ends of the long bones of the arms and legs, affecting the hips, knees, shoulders, and wrists. In adults, it is more common in the bones of the spine (vertebrae) or in the pelvis.

Causes of Osteomyelitis

There are several different ways to develop osteomyelitis. The first is for bacteria to travel through the bloodstream (bacteremia) and spread to the bone, causing an infection. This most often occurs when the patient has an infection elsewhere in the body, such as pneumonia or a urinary tract infection that spreads through the blood to the bone.
An open wound over a bone can lead to osteomyelitis. An open fracture where the bone punctures through the skin is also a potential cause. A recent surgery or injection around a bone can also expose the bone to bacteria and lead to osteomyelitis.
Patients with conditions or taking medications that weaken their immune system are at a higher risk of developing osteomyelitis. These include patients with cancer, chronic steroid use, sickle cell disease, human immunodeficiency virus (HIV), diabetes, hemodialysis, intravenous drug users, and the elderly.

Symptoms of osteomyelitis

Osteomyelitis symptoms can vary greatly. In children, osteomyelitis most often occurs more quickly. They develop pain or tenderness over the affected bone, and they may have difficulty or inability to use the affected limb or to bear weight or walk due to severe pain.
In adults, the symptoms often develop more gradually. Other symptoms include fever, chills, inflammation of the bones, irritability, swelling or redness over the affected bone, stiffness, and nausea.

Treatment for Osteomyelitis

The goal of osteomyelitis treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues.
Antibiotics are given to destroy the bacteria causing the infection. You may receive more than one antibiotic at a time. Often, the antibiotics are given through an IV (intravenously, meaning through a vein) rather than by mouth. Antibiotics are taken for at least 4 - 6 weeks, sometimes longer.
Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. If there are metal plates near the bone infection, they may need to be removed. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue.
Infection of an orthopedic prosthesis, such as an artificial joint, may need surgery to remove the prosthesis and infected tissue around the area. A new prosthesis may be implanted in the same operation. More often, doctors wait to implant the prosthesis until the infection has gone away. If you have diabetes, it will need to be well controlled. If there are problems with blood supply to the infected area, such as the foot, surgery to improve blood flow may be needed.

Complications

When the bone is infected, pus is produced in the bone, which may result in an abscess. The abscess steals the bone's blood supply. The lost blood supply can result in a complication called chronic osteomyelitis. This chronic infection can cause symptoms that come and go for years. Other complications include:

  • Need for amputation
  • Reduced limb or joint function
  • Spread of infection to surrounding tissues or the bloodstream

Osteomyelitis Management

Prompt and complete treatment of infections is helpful. People who are at high risk or who have a compromised immune system should see a health care provider promptly if they have signs of an infection anywhere in the body.

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