Osteomyelitis

Osteomyelitis is an inflammation of the bone or bone marrow, which is most commonly caused by a bacterial infection. Fungi are the other, less likely, offenders.

Though it’s not always possible to pinpoint the exact origin of infection, these microorganisms can infect the bones in the following ways:

  • Bacteria enters the bone through a traumatic or surgical wound
  • Bacteria travels through the bloodstream from other infected areas in the body
  • Infection spreads to the bone from an adjacent, soft-tissue wound

Symptoms
The most common symptoms of osteomyelitis include discomfort in the affected area, fevers or night sweats, lack of energy and weight loss.  Warning signs include persistent drainage from a wound that will not heal on its own, swelling and redness in the area of the surgical incision.  

Risk Factors
Those who are most at risk for developing osteomyelitis are individuals who fall under the following categories:

  • Cancer
  • Chronic lymphedema
  • Diabetic
  • Elderly
  • Extensive scarring
  • Large surgical implants (i.e., total joint prosthesis)
  • Organ failure
  • Poor nutrition
  • Previous radiation therapy
  • Steroids use
  • Use of tobacco products

Diagnosis

  • Blood tests
    While blood tests will not provide a positive or negative diagnosis of osteomyelitis, they can reveal indicators consistent with the body’s response to an existing inflammation or infection.

  • Bone scan
    A bone scan uses an injectable, radioactive substance to monitor a bone’s metabolic activity. Although the technology can detect subtle changes in bone before they are visible on a regular X-ray, it cannot discern the cause of the activity.

  • Computerized tomography (CT) Scans
    The computer generated, cross-sectional X-ray images which are produced by a CT scan are useful in the diagnosis of:

    • Areas of bone destruction
    • Fluid collections
    • Soft tissue abnormalities
  • Imaging tests
    Diverse imaging techniques; above and beyond a standard X-ray, are often required for an accurate diagnosis.

  • Magnetic resonance imaging (MRI)
    An MRI harnesses the power of radio waves and magnetic fields to produce the most sensitive and specific form of imaging technology available. The images provide enhanced insight into the extent of the infectious process in both bone and soft tissue.

  • Surgical tests
    Currently, the most accurate way of isolating and identifying the organism(s) causing an osteomyelitis infection is to do a bone biopsy at the site of infection.

  • White blood cell scan
    A white blood cell (WBC) scan helps differentiate between noninfected areas of activity on a bone scan by tagging a patient’s white blood cells with a radioactive element.

Treatment Options
Orthopedic medicine and surgery have made major strides in recent decades. In the 1970s, those who developed osteomyelitis were told the only way to cure chronic osteomyelitis was amputation. Today, there is a select handful of physicians who specialize in the evaluation and treatment of orthopedic infections. They include Sharp-affiliated surgeons who draw osteomyelitis patients from across the globe.   

Individualized treatment options are based on a number of factors, including:

  • Location of infection
  • Overall health of the patient
  • Quality of bone and soft tissue
  • Severity of infection

The most common treatments for osteomyelitis include a combination of medical (local and systemic antibiotics) and surgical protocols.

Surgical treatments may include one or more of the following procedures:

  • Drainage of the infected area
  • Reconstruction to restore form and function
  • Removal of infected hardware, prosthetic joint implants, dead bone and/or foreign bodies; such as suture material or retained bone cement

For More Information
To learn more about orthopedics at Sharp or to find a Sharp-affiliated doctor, search San Diego orthopedic surgeons or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about orthopedics, visit Orthopedic Surgery in Adult Health or read the Orthopedic News archive.