What is sternal osteomyelitis?
Osteomyelitis is primarily an infection of a bone. These infections can reach the bony area through the blood or can spread into the surrounding tissue. However, sometimes the infection can start in the bone itself if an injury has left the bone exposed to bacteria and germs.
In children, osteomyelitis often affects the long bones of the legs and arms, while in adults it is more common in the vertebrae of the spine.
In the case of sternal osteomyelitis, it is a rare disease in children, as it usually and almost half of the cases usually occur in the tibia and femur. In adults, sternal osteomyelitis can occur after open heart surgery, retrosternal abscess, surgery or trauma to the thorax, bone marrow biopsy… However, in cases where there is no triggering factor, it is very rare.
Prognosis of sternal osteomyelitis
In the past, osteomyelitis was considered an incurable disease, although nowadays the progress of science and medicine means that it can be treated satisfactorily. Normally surgery is used to remove the dead parts of the bone and then treatment with intravenous antibiotics is started.
However, the prognosis is not favorable for those in whom the osteomyelitis has been prolonged over time, i.e. has become chronic. In these cases, symptoms may appear and disappear over time, despite surgery. If the infection is in the extremities and the patient has poor circulation or diabetes, amputation may even be necessary.
At the same time, the possible complications of the disease, which can lead to bone death, skin cancer and, in children, growth disturbances, should be taken into account.
Symptoms of sternal ostemyelitis
A person with osteomyelitis usually suffers from pain in the infected bone. There are also secondary symptoms that may occur in some cases:
- Feeling of general malaise and tiredness.
- Fever
- Nausea
- Inflammation of the skin covering the area of the infected bone.
- Hyperhidrosis or excessive sweating
- Feeling of strong local heat in the area
- Irritability or lethargy in young children
- Numbness of the area
Occasionally, osteomyelitis is not accompanied by pain and hardly produces any signs, and the few that are shown are difficult to distinguish from other diseases or disorders.
Location of the sternum in the body
Medical tests for sternal osteomyelitis
The diagnosis of osteomyelitis is sometimes contradictory and is often confused with other pathologies. At the same time, the disease can be virtually asymptomatic, so its diagnosis may not be straightforward.
It is common for the specialist to palpate and touch the area near the infection to see how the patient reacts to touch and to detect possible swelling or temperature.
When it comes to testing, a blood test is one of the key tests, as it can reveal the levels of white blood cells present in the blood and other indicators that the body is fighting an infection. In turn, if the cause or origin of the disease is a blood infection, the analysis may even reveal the causative particles.
Imaging tests, in turn, make it possible to observe the state of the bone, and can therefore observe whether or not there is damage to the bone. The imaging tests are:
- X-ray
- Computed tomography
- Magnetic resonance imaging
Finally, the bone biopsy allows the diagnosis of osteomyelitis while pointing out which bacteria or germs have infected the bone. Knowing which germ has infected the bone allows specialists to choose the correct antibiotic to treat the infection.
In order to perform an open bone biopsy, anesthesia and surgery are necessary to access the bone. However, sometimes the specialist can use a long needle that is inserted through the skin and allows the biopsy to be performed in a less invasive way than surgery. Local anesthesia is usually used.
What are the causes of sternal osteomyelitis?
Bone infection is almost always caused by bacteria, although sometimes it may be caused by fungi or other germs. When a person suffers from osteomyelitis, the following may happen:
- The bacteria or microorganism(s) causing the infection may move into the bone from the skin, tendons or muscles. This may occur under a skin ulcer.
- The infection may originate in one area of the body and reach and infect another through the blood. Germs that are in the blood can travel through the bloodstream and reach a weak area of bone.
- Infection can occur after bone surgery. It is more common if the intervention is done after the injury or if metal plates are placed in the bone.
- Open wounds: if there has been a break with an open wound, germs can enter the body through the wound.
In turn, there are a number of risk factors that can facilitate the development of osteomyelitis:
- The patient has recently suffered an injury or orthopedic surgery. Implantation of orthopedic devices and bite wounds are easily infectious.
- The patient has circulation disorders. There are diseases that can obstruct or injure blood vessels, such as poorly controlled diabetes, artery disease – which may be caused by smoking – and sickle cell disease.
- Problems requiring intravenous lines or tubes
- Disorders that affect the immune system, such as chemotherapy.
Can osteomyelitis be prevented?
The best way to avoid osteomyelitis is to avoid wounds and cuts, and if they do occur, to immediately clean the area to prevent microbes from entering the body.
By monitoring wound healing and wound status to control infection, the risk of infection and therefore osteomyelitis will be reduced.
Treatments for sternal osteomyelitis
The goal of treatment is to stop the infection and reduce the damage it may have caused to the bone and surrounding tissues. Antibiotic treatment to kill the bacteria causing the infection is essential and is usually taken for four to six weeks and given intravenously.
In the event that the infection does not go away with medication, surgery may be required to remove the affected area. In the case of infection with metal plates nearby, they may need to be removed.
Infection after arthroplasty may require removal of the replaced joint, and a new prosthesis may be implanted at the same time.
Depending on the severity of the infection, surgery may be necessary to remove the infected parts of the bone. Depending on the severity, the following procedures may be performed:
- Drainage of the area
- Removal of the diseased tissue and/or bone.
- Restoration of blood flow to the bone
- Removal of external objects
- Amputation
What specialist treats osteomyelitis?
Osteomyelitis is diagnosed and treated by the orthopedic surgeon and the orthopedic surgeon.