Osteomyelitis: what is it and how is it treated

What is osteomyelitis?

Osteomyelitis is the infection of bone tissue caused by a pathogenic microorganism, usually bacteria. There are two types, acute osteomyelitis (the classic one in children) and chronic osteomyelitis (the most frequent). The presence of dead bone (“bone sequestration”) and the existence of a bacterial biofilm are the fundamental characteristics of chronic osteomyelitis.

Why does osteomyelitis occur?

Osteomyelitis is caused by pathogenic microorganisms (bacteria) reaching the bone. In adults, it most commonly occurs as a consequence of an open fracture, after surgery (enhanced by the presence of plates, screws or pins) or by a skin defect with bone exposure (common in diabetic patients, with vascular problems or with mobility problems). Osteomyelitis can sometimes show up months or even years after the initial injury.

Which bones are usually affected?

Osteomyelitis can affect any bone of the skeleton. The tibia is usually the most affected bone because it is the bone most frequently involved in complex trauma and because of its poor soft tissue protection. In diabetic patients, the bones of the foot are very frequently affected.

What are the consequences of not treating it in time?

Osteomyelitis can cause great functional and social alteration. It is frequent that the patient has been dragging the infection for years, without finding a solution and possibly having undergone several surgeries throughout his life. Patients often hear that a bone infection is “forever” but osteomyelitis, once considered an incurable disease, can now be treated successfully and definitively.

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What are the symptoms and how is it diagnosed?

Osteomyelitis can present itself in the form of very diverse and varied clinical pictures, ranging from a mild infection, which only causes occasional discomfort to the patient, to being the reason that a fracture does not consolidate (infected pseudoarthrosis) and even endangering the limb or even the patient’s life. Like other infections based on the existence of a bacterial biofilm, on many occasions osteomyelitis is not accompanied by the typical signs that we all associate with the existence of an infection, such as fever, redness, local increase in temperature, etc. It is also important to take into account that the skin is usually affected (ulcers, fistulas, scars, unstable skin…) in many cases, this being a fundamental factor in the perpetuation of the infection. As we have said, osteomyelitis can appear months or years after the initial lesion, and it is difficult for the patient to accept the cause-effect relationship with events that may have happened years ago.

What treatment does it require?

Osteomyelitis is an eminently surgical entity. Only through surgery can we cure an infection in the bone tissue. It is a complex surgery that should only be performed by surgeons who are experts in this type of procedure. The treatment of osteomyelitis is based on two principles which are analogous to the treatment of tumors, i.e. surgical removal of all affected bone and soft tissues, together with appropriate adjuvant local and systemic antibiotic treatment (chemotherapy). Occasionally, eradication of the infection requires major bone resections, which results in the need for complex reconstructive procedures.

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For more information on osteomyelitis contact a specialist in Traumatology.