Osteomyelitis is an infection of the bone. This may develop through spreading of bacteria via the blood or, most commonly in adults, by direct inoculation of a previous surgical site or an open (compound) fracture.
Your bones are normally resistant to infection. In order for osteomyelitis to occur, a situation that makes your bones vulnerable must be present. For example, trauma to your bone, such as a fracture, or to the soft tissue around your bone, such as a puncture wound, gives infections a route to enter your bone or nearby tissue.
You may also be vulnerable to infection if you have a condition that weakens your body's ability to fight an infection, such as diabetes.
Osteomyelitis occurs in children most commonly as an acute condition — meaning that signs and symptoms last several months or less. In adults, osteomyelitis is most commonly a chronic condition, lasting several months to years.
Whether osteomyelitis is acute or chronic determines the treatment, as children with acute osteomyelitis may be treated with antibiotics alone. Adults with chronic osteomyelitis usually require surgery in addition to antibiotics.
Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish, however chronic osteomyelitis in adults may commonly cause:
- Warmth, swelling and redness over the area of the infection
- Pain or tenderness in the affected area
- Drainage from an open wound near the area of the infection
- Fever in some cases
As always, a good history and physical exam can lead the orthopedic surgeon to suspect osteomyelitis. X-rays are also important as changes related to bone infection can be detected. Often times x-rays do not show any bone damage and other diagnostic tests such as MRI and bone scans may be required. Blood tests can also help in the diagnosis of osteomyelitis.
Osteomyelitis of the limb can put one at high risk for major limb amputation, and often requires coordinated care between the orthopedist, infectious disease specialist, and other surgical specialists such as vascular and plastic surgeons.
Staged surgical procedures are often required to eradicate the infection before proceeding with reconstruction of the joint or long bone. Advances in circular external fixation have allowed orthopedic surgeons to treat severe cases of osteomyelitis which otherwise would have resulted in amputation.
Dr. Chapman is experienced in limb salvage techniques for osteomyelitis and is able to coordinate care with the other medical and surgical specialists needed to treat this difficult problem.