Osteomyelitis is inflammation of the bone tissue or the bone marrow. It may affect virtually any bone in the body and it may lead to many complications.
Classic osteomyelitis is an infectious process, which occurs when the bone tissue is attacked by any microorganism, typically by bacteria. Quite often it is caused by staphylococci. The bacteria can get into the bones from outside in open fractures or they may be taken there with blood in septic conditions. Increased risk of bone infections is in patients after various surgical and orthopedic procedures, such as after the artificial arthroplasty. Acute cases of osteomyelitis occur rather in children and chronic forms are more typical for the adults and patients with weakened immunity.
In children, long bones are the most commonly affected, while adults typically suffer from infections of the vertebrae and pelvic bones. Acute osteomyelitis manifests with fever, chills and pain of the affected bone. Surrounding tissues are swollen and painful on touch. White blood cells travel to the site of inflammation, destroy bacteria and the process can even destroy parts of the infected bone. Abscesses (cavities filled with pus) may emerge in the site of infection and local fistulae may cause drainage of pus towards the body surface. The inflammation relatively frequently shifts to chronic phase, which manifests with just slightly elevated temperature (usually below 38°C) and there is continuous purulent discharge from the fistulae without tendency to spontaneous healing.
The symptoms and positive physical examination may be suspicious. In blood tests, we find signs of inflammation such as increased number of white blood cells and elevated CRP. The X-ray is a good basic imaging method to visualize bones and their pathologies. Computed tomography is great in evaluation of the extent of bone damage and neighboring soft tissues including abscesses and fistulae. It is advisable to take the blood cultures as there is a high possibility that the bacteria have spread from the bone into the bloodstream. The evaluation of the bacterial presence and their sensitivity to antibiotics may be crucial for subsequent treatment.
The treatment is difficult. Antibiotics in high doses must be used, but their effect within bones is, however, very limited. Sometimes it may be necessary to perform surgery, remove any necrotic tissue, clean the wound and ensure drainage of pus. When there is an unmanageable infection of a limb bone, the last possible option is amputation of the affected extremity.