Osteomyelitis is an acute or a chronic infection of the bone-forming tissue. Such infections are characterized by inflammation, edema, and circulatory congestion of the bone marrow. As the infection progresses, pus may form and sustained inflammatory pressure may cause fracturing of small pieces of bone. Osteomyelitis usually begins as an acute infection, but it may evolve into a chronic condition. The disease is more common in children, especially boys, in whom it often begins in the acute form.
Osteomyelitis is most often caused by trauma resulting in hematoma formation and an acute bacterial infection, particularly by Staphylococcus aureus. Viruses and fungi somewhere else in the body also may cause the condition. The infectious microorganisms may reach the bone marrow through the blood or by spreading from infected adjacent tissue; they can also be introduced directly into the bone tissue following physical trauma or surgery. Infection commonly affects the long bones in the arms and legs. The spine and pelvis may also be involved. Diabetes mellitus may predispose an individual to osteomyelitis because of poor circulation, as may the presence of prosthetic hardware (screws, plates, rods) within the bone. Individuals on hemodialysis, those with their spleen removed, and those who illegally inject drugs are also at high risk.
Signs and Symptoms
Specific signs and symptoms depend on which bone or bones are affected and the virulence (strength) of the infecting microorganism. Generalized symptoms may include the sudden onset of fever, chills, malaise, sweating, pain, and tenderness and swelling over the affected bone. In the acute phase, fever is abrupt and children can show irritability and fatigue. The chronic phase may exhibit drainage or seeping from an open wound near the infection site, and the client may have intermittent fever and chronic fatigue. Both the acute and chronic forms of osteomyelitis may exhibit the same clinical picture, although the chronic form may persist for years before it is detected following a flare-up due to minor trauma.
A physical examination reveals bone tenderness, redness, and possibly swelling. Blood cultures or aspiration and culture of fluid from the infection site are essential to isolate the causative microorganism. X-rays and bone scans may prove helpful in determining the site and extent of the infection.
The goal of treatment is to eliminate the infection. Bed rest and parenterally administered antibiotics often suffice. If not, surgical drainage to remove pus and dead bone may be necessary. Tissue and/or bone grafts may be necessary to restore blood flow to the site. Immobilization of the affected body part and analgesics may be required.
No significant complementary therapy is indicated.
The goals are to control the infection and to protect the bone from injury. Teach clients how to avoid spreading infection by immediate cleaning and bandaging of any scrapes or cuts. Remind those at risk how to better protect themselves from injury.
With today’s therapeutic options, osteomyelitis frequently resolves favorably. If the acute form of the disease progresses to a chronic form, the prognosis is less favorable. There can be bone and joint deformities and impaired bone growth in children.
Resistant or extensive chronic osteomyelitis may result in amputation, especially in persons with diabetes or with poor blood circulation. Clients often experience a fair amount of pain and require lengthy hospitalization.
Extreme care must be taken during surgery or following trauma to prevent contamination so that the disease does not have a chance to develop. Wounds should be cleaned and bandages replaced. The site should be checked often for signs of infection. Prompt and complete treatment of infections is helpful.