Osteomyelitis is a serious bone infection that can, if untreated, cause life-threatening complications and permanent physical impairment.
VA rates chronic, or recurring, suppurative osteomyelitis under Diagnostic Code § 4.43 and considers the condition a “continuously disabling process,” which entitles afflicted veterans to a permanent rating if it is not resolved via complete amputation, and thus eradication, of the infection.
Osteomyelitis is a painful bone infection. It usually goes away if treated early with antibiotics. If not, it can cause permanent damage.
The goal for treatment of osteomyelitis is to cure the infection and minimize any long-term complications. Osteomyelitis calls for long-term care to prevent complications.
Osteomyelitis is caused by an infection of the bone or joint, and can be both acute and chronic. It can occur at any age and involve any bone.
Long-term Considerations for Osteomyelitis
Fractures of the affected bone. Stunted growth in children (if the infection has involved the growth plate) Gangrene infection in the affected area.
Chronic osteomyelitis is a relatively common infection and is often a lifelong disease.
Acute osteomyelitis typically refers to an infection of less than 1 month's duration, whereas chronic osteomyelitis refers to infection that lasts longer than 4 weeks.
Osteomyelitis extending for > 3 months, bone exposure and treatment other than surgical debridement with muscular flap are risk factors for osteomyelitis relapse.
Although osteomyelitis is a difficult problem, certain conditions make it even more difficult to address. Diabetes, peripheral vascular disease, and radiation are all comorbidities that interfere with wound healing and therefore make the treatment of osteomyelitis challenging.
Staphylococcus aureus is the most common cause of acute and chronic hematogenous osteomyelitis in adults and children.
Reactivation of osteomyelitis, even after a 50-year disease-free interval, has been reported in the literature (6). In daily clinical practice, these recurrences are not rare and usually occur at the prior anatomical site of infection without any history of concomitant disease, bacteremia, or new trauma.
In adults, the vertebrae are the most common site of hematogenous osteomyelitis, but infection may also occur in the long bones, pelvis, and clavicle. Primary hematogenous osteomyelitis is more common in infants and children, usually occurring in the long-bone metaphysis.
Individuals who have a muscle or bone disorder and are unable to work as a result may be eligible for Social Security Disability benefits. These benefits are available to individuals whose disability prevents them from working for 12 months or more.
Chronic pain, an area of erythema around the affected bone, swelling and bone tenderness, impaired wound healing often associated with tissue necrosis, increased drainage or persistent sinus tracts, chills, low grade fever and general malaise are some of the most commonly reported clinical symptoms (Fig. 1).
Cierny and Mader proposed an anatomic classification of chronic osteomyelitis : Type 1 — Endosteal or medullary lesion. Type 2 — Superficial osteomyelitis limited to the surface. Type 3 — Localized, well-marked legion with sequestration and cavity formation.
7, 8 The prevalence of malignant transformation in the setting of chronic osteomyelitis ranges from 1.6% to 23%, and the most commonly affected bones are the tibia and femur. The most frequently observed malignant transformation is squamous cell carcinoma of the skin.
The overall success rate was 96.2 % (95 % CI 80.4–99.9 %) at a minimum of 12-months follow-up. Remission was achieved in all [11/11] patients treated curatively (one-sided 95 % CI 73.5–100.0 %). Palliative treatment was successful in 92.9 % [13/14] of cases (95 % CI 66.1–99.9 %).
The infection spreads to the bone after several days or weeks. This type of spread is particularly likely to occur in older people. Such an infection may start in an area damaged by an injury or surgery, radiation therapy, or cancer or in a skin ulcer (particularly a foot ulcer) caused by poor circulation or diabetes.
Acute osteomyelitis presents within 2 weeks after disease onset, subacute osteomyelitis within one to several months, and chronic osteomyelitis after a few months.
Osteomyelitis is a severe, progressive inflammatory process caused by an infecting microorganism leading to bony destruction, which can be limited to a single portion of the bone or can be multifocal.
Osteomyelitis is most common in young kids under age 5. But it can happen at any age. Boys get it almost twice as often as girls do.
Without treatment, the infection and inflammation block blood vessels. The lack of oxygen and nutrients cause the bone tissue to die, which leads to chronic osteomyelitis. Other possible complications include blood poisoning and bone abscesses.
The subacute and chronic forms of osteomyelitis usually occur in adults. Generally, these bone infections are secondary to an open wound, most often an open injury to bone and surrounding soft tissue.
The pathogenesis of osteomyelitis is linked to both environmental and genetic factors.