Osteomyelitis is the medical term for an infection in a bone. Infections can reach a bone by traveling through your bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if trauma exposes your bone to germs. Bone infections commonly affect the long bones of your body, such as your leg bones and upper arm bone, as well as your spine and pelvis.

Complications of Osteomyelitis

• The infection that causes osteomyelitis can usually be controlled. But a risk of recurrence always remains. Osteomyelitis that returns or continues undetected for years is considered chronic osteomyelitis. Chronic osteomyelitis can lead to the death of bone tissue and the collapse of the bone.
• Osteomyelitis that can't be controlled may require drastic treatment in order to prevent spread to other parts of your body. When this occurs in arms and legs, drastic treatment may mean amputation of the affected limb.

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.

Signs & Symptoms of Osteomyelitis

Signs and symptoms of osteomyelitis depend on whether the condition is acute, lasting several months or less, or chronic, lasting several months to years.

Signs and symptoms of acute osteomyelitis include:

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

Signs and symptoms of chronic osteomyelitis include:

• Warmth, swelling and redness over the area of the infection.
• Pain or tenderness in the affected area.
• Chronic fatigue.
• Drainage from an open wound near the area of the infection.
• Fever, sometimes.

Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems. For instance, osteomyelitis of the hip, spine or pelvis may have few signs and symptoms. Osteomyelitis that occurs after a broken bone (fracture) or deep wound may cause pain and swelling that you may attribute to your injury, not an infection.

Diagnosis of Osteomyelitis

Your doctor conducts a physical exam to better understand your signs and symptoms if he or she suspects you may have osteomyelitis. Your doctor may feel the area around the affected bone for any tenderness, swelling or warmth. Your doctor may order a combination of tests and procedures to diagnose osteomyelitis and to determine what type of infection you have, including:

• Blood tests. Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If your osteomyelitis was caused by an infection in the blood, tests may reveal what germs are to blame. No blood test exists that tells your doctor whether you do or do not have osteomyelitis. However, blood tests do give clues about your diagnosis, which your doctor uses to decide what further tests and procedures you may need.
• X-rays. X-rays can reveal damage to your bone. However, damage may not be visible until osteomyelitis has been present for several weeks. More-detailed imaging tests may be necessary if your osteomyelitis has developed more recently.
• Other imaging procedures. If your doctor can't get a clear picture of the affected bone using X-ray, he or she may order other imaging procedures, such as computerized tomography (CT), magnetic resonance imaging (MRI) or a bone scan.
• Bone biopsy. During a biopsy, a surgeon removes a small piece of your infected bone for analysis in a laboratory. The laboratory determines what type of bacteria or other pathogen is infecting your bone. Your doctor uses that information to determine your treatment. A biopsy can be performed as an open biopsy, meaning that it requires anesthesia and surgery to access the bone. In some situations, a surgeon inserts a long needle into your skin and your bone to take a biopsy (fine-needle aspiration). This procedure requires local anesthetics to numb the area where the needle is inserted.

Treatments of Osteomyelitis

• In many cases, osteomyelitis can be effectively treated with antibiotics and pain medications. If a biopsy is obtained, this can help guide the choice of the best antibiotic. In some cases, the affected area will be immobilized with a brace to reduce the pain and speed the treatment.
• Sometimes, surgery may be necessary. If there is an area of localized bacteria (abscess), this may need to be opened, washed out, and drained. If there is damaged soft tissue or bone, this may need to be removed. If bone needs to be removed, it may need to be replaced with bone graft or stabilized during surgery.

Prevention of Osteomyelitis

• If you've been told that you have an increased risk of infection, talk to your doctor about ways to prevent infections from occurring. Reducing your risk of infection will also reduce your risk of developing osteomyelitis.
• In general, be careful and take precautions to avoid cuts and scrapes, which give germs easy access to your body. If you do get any cuts and scrapes, clean the area immediately and apply a clean bandage. Check wounds frequently for signs of infection.

When to seek Medical Advice

See your doctor if you experience worsening bone pain along with signs and symptoms of an infection, such as fever and chills. If you're at risk of infection because of a medical condition or recent surgery or injury, see your doctor right away if you notice signs and symptoms of an infection.