OSTEOMYELITIS

General Information

DEFINITION--Infection of the bone and bone marrow.

BODY PARTS INVOLVED--Any bone in the body. In a child, the femur (upper-leg bone), tibia (lower-leg bone) or humerus or radius (bones in the arm) is usually affected. In an adult, the pelvis or spine is usually affected.

SEX OR AGE MOST AFFECTED

• Both sexes, but more common in males.
• All ages, but most common in rapidly growing children (5 to 14 years).

> Pain, swelling, redness, warmth and tenderness in the area over the infected bone, especially when moving a nearby joint. Nearby joints--especially the knee--

may also be red, warm and swollen.

• If a child is too young to talk, signs of pain are: reluctance to move an arm or leg or refusal to walk; limping; or screaming when the limb is touched or moved.
• Pus drainage through a skin abscess, without fever or severe pain (chronic osteomyelitis only).
• General ill feeling.

CAUSES--

Usually staphylococcal infection, but many other bacteria may be responsible. The bacteria may spread to the bone through the bloodstream from the following sources:

• Compound fracture or other injury.
• Boil, carbuncle or any break in the skin.
• Middle-ear infection.
• Pneumonia.

RISK INCREASES WITH

• Illness that has lowered resistance.
• Rapid growth during childhood.
• Diabetes mellitus.
• Implanted orthopedic device (artificial knee).
• Intravenous drug use.

HOW TO PREVENT--Obtain prompt medical treatment of any bacterial infection to prevent its spread to bone or other body parts.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood studies and blood cultures to identify the bacteria.
• Radionuclide bone scans, CT or MRI scans (See Glossary for all). X-rays often don't show changes until 2 to 3 weeks after the infection begins.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Hospitalization may be necessary for surgery to remove pockets of infected bone and/or to administer high doses of antibiotics sometimes intravenously.
• A previously implanted orthopedic device (artificial knee) may need to be removed (sometimes a replacement can be implanted at the same time).

POSSIBLE COMPLICATIONS

• Abscess that breaks through the skin and won't heal until the underlying bone heals.
• Permanent stiffness in a nearby joint (rare).
• Fracture.
• Loosening of implanted orthopedic device.
• May require amputation if circulation blocked or severe gangrene infection occurs (rare).

PROBABLE OUTCOME--Usually curable with prompt and aggressive treatment.

How To Treat

GENERAL MEASURES--

• Keep the involved limb level or slightly elevated and immobilized with pillows. Don't let it dangle.
• Keep unaffected parts of the body as active as possible to prevent pressure sores during required, prolonged bed rest.

MEDICATION--Your doctor may prescribe:

• Large doses of antibiotics. With powerful new antibiotics, intravenous administration, once a necessity, may no longer be needed. Antibiotics may be necessary--either orally or by injection--for 8 to 10 weeks.
• Pain relievers.
• Laxatives, if constipation develops during prolonged bed rest.

ACTIVITY--Rest in bed until 2 to 3 weeks after symptoms disappear. Resume your normal activities gradually.

DIET--No special diet. Eat heartily. Take vitamin and mineral supplements if needed.

Call Your Doctor If

• You or your child have symptoms of osteomyelitis.
• The following occurs during treatment: An abscess forms over the infected bone or drainage from an existing abscess increases. Fever. Pain becomes intolerable.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.