In more severe cases, and for chronic osteomyelitis, surgery may be needed to remove damaged bone or tissue, or infected plates or screws. Osteomyelitis can be successfully treated. However, it is important to prevent it from happening again. Your doctor will advise you on the steps you should take.
Osteomyelitis surgery is used when antibiotics are not able to treat the bone infection. The surgery occurs in two parts. First, surgeons clean the bone and/or marrow cavity to remove infection, and then they cut away any dead bone in the area of the infection.
Osteomyelitis is more common in younger children (five and under) but can happen at any age. Boys are usually more affected than girls. Antibiotics are often prescribed to treat osteomyelitis. Surgery may also be recommended in certain cases.
Stage 4, or diffuse, osteomyelitis involves the entire thickness of the bone, with loss of stability, as in infected nonunion. The Cierny-Mader system adds a second dimension, characterizing the host as either A, B, or C. The A hosts are patients without systemic or local compromising factors.
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.
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.
The crude mortality rate of osteomyelitis associated with diabetes increased with age (<55 years: 0.50, 95% CI: 0.48–0.52; 55 to 64 years: 5.49, 95% CI: 5.30–5.67; 65 to 74 years: 11.77, 95% CI: 11.44–12.10; 75 to 84 years: 21.82, 95% CI: 21.25–22.40; and 85+ years: 36.86, 95% CI: 35.67–38.05).
Outlook (Prognosis)
With treatment, the outcome for acute osteomyelitis is often good. The outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially in people with diabetes or poor blood circulation.
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. Treatment options include intravenous and oral antibiotics, and surgical draining and cleaning of the affected bone tissue.
The overall success rate was 96.2 % (95 % CI 80.4–99.9 %) at a minimum of 12-months follow-up.
In adults, osteomyelitis most often affects the vertebrae of the spine and/or the hips. However, extremities are frequently involved due to skin wounds, trauma and surgeries.
DOs and DON'Ts in Managing Osteomyelitis:
DO take the full course of antibiotics. DO change position in bed often to prevent pressure sores. Check skin for redness at pressure points. DO isometric exercises often to prevent muscle weakness and maintain joint flexibility.
Bone culture remains the reference standard for the microbiological diagnosis of osteomyelitis; consecutive deep sinus tract cultures may be used when a biopsy cannot be performed [28]. 8.
Emergency Department Care
Osteomyelitis rarely requires emergent stabilization or resuscitation. The primary challenge for ED physicians is considering the appropriate diagnosis in the face of subtle signs or symptoms.
Leading complications resulting from chronic osteomyelitis include sinus tracts and extension to adjacent structures, as well as abscess formation. One complication that must not be missed is malignant transformation (ie, Marjolin ulcer).
Bone death: Also called osteonecrosis, bone death can occur if swelling from the infection cuts off blood flow to your bone. Very rarely, this may lead to loss of a limb or amputation. Stunted growth: Osteomyelitis in a growing child may stunt bone growth.
In such late infections, a compromised healing process often occurs, and although bone healing may have occurred in some cases, severe inflammation is possible, and osteolysis accompanied by osteomyelitis may cause unstable osteosynthesis (Fig. 2).
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. Some children have a higher risk of developing osteomyelitis, such as those with a weak immune system or chronic conditions like sickle cell disease.
Brain abscess is the commonest complication of skull osteomyelitis. This is usually associated with subperiosteal abscess. Frontal lobe abscess present as subtle personality changes. Radiological features vary with the duration of the infection.
Osteomyelitis is very serious and if left untreated, can lead to necrosis or cell death. If necrosis is left untreated, it can lead to sepsis, which is infection in the blood. Sepsis can lead to multiple organ failure and eventually death.
Chronic osteomyelitis can destroy the bone, can sometimes spread to the bloodstream and may increase mortality risk. People at risk for osteomyelitis are those who have: Skin infections. Open wounds near a broken bone that breaks into skin.
Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals. Germs can enter a bone in a variety of ways, including: The bloodstream.
The hallmark of chronic osteomyelitis is the presence of dead bone (sequestrum). Other common features of chronic osteomyelitis include involucrum (reactive bony encasement of the sequestrum), local bone loss, and, if there is extension through cortical bone, sinus tracts.