How does infection get into the bone?
The bone is well protected, and inflammation does not simply occur in it. You need either the introduction of microbes by blood from another source (sore throat, boil, urinary tract infection), or direct damage - a wound, a knitting needle, an implant, an open fracture. In children, the hematogenous route with damage to the growth zones of long bones is more common, in adults - post-traumatic and postoperative. A separate option is the transition of inflammation from soft tissue to bone in diabetic foot and bedsores.
- Hematogenous - the introduction of bacteria with blood, typical for children
- Post-traumatic - after an open fracture or deep wound
- Postoperative - around wires, plates, endoprosthesis
- Contact - transfer of infection from an ulcer, bedsore, inflamed joint
- Odontogenic - from a lesion in a tooth to the jawbone
Who gets sick more often: risk factors
The risk is increased by conditions in which the blood supply to the bone is impaired or the body's defenses are weakened. People with diabetes are especially vulnerable: decreased sensation in the feet leads to invisible wounds, and poor blood flow interferes with healing. Chronic kidney disease, cancer, and taking medications that suppress the immune system are also important. In children, the trigger is often a recent infection or bruise, after which the child begins to spare the limb.
- Diabetes mellitus and diabetic foot
- Peripheral artery diseases
- Open and gunshot fractures
- Metal structures and endoprostheses
- Immunodeficiency, taking glucocorticoids and cytostatics
- Intravenous drug use
Symptoms of acute and chronic form
Acute osteomyelitis develops over several days: severe pain appears deep in the bone, which does not go away with rest and interferes with sleep, the temperature rises, and the general condition suffers. The skin above the lesion turns red and becomes hot, movements are severely limited. The chronic form looks different - periods of calm are replaced by exacerbations, fistulas form on the skin, from which pus is released, and sometimes small bone fragments emerge. The pain is moderate, and the general condition remains satisfactory for a long time.
- Deep arching pain in the bone
- Fever, chills, weakness
- Swelling and redness over the affected area
- Limitation of movements, gentle gait
- Fistula with purulent discharge in chronic course
- In young children, refusal to use an arm or leg
What examinations are needed
X-rays in the first days of the disease may be normal: characteristic bone changes appear only after one to two weeks. Therefore, if an acute process is suspected, the doctor relies on the clinical picture and tests, and for early confirmation prescribes an MRI - it shows bone marrow edema and purulent accumulations. The key point is to obtain material for culture: before starting antibiotics, blood is taken, and during surgery, a bone fragment is taken. This allows you to select a drug to which the pathogen is sensitive.
- X-ray of the bone in two projections, repeated after 10–14 days
- MRI is the most sensitive method in the early stages
- CT scan - assessment of sequesters and cavities before surgery
- Complete blood count with ESR, C-reactive protein, procalcitonin
- Culture of blood and material from the lesion with determination of sensitivity
- Ultrasound of soft tissues to look for collections of pus
Treatment and recovery
Treatment is always combined. Antibiotics are prescribed intravenously, and the course is continued for several weeks, sometimes up to one and a half to two months - this fundamentally distinguishes osteomyelitis from a common soft tissue infection. The surgeon opens and washes the abscess, removes dead bone and non-viable tissue, if necessary, removes the infected metal structure and installs drainage. The limb is fixed to avoid pathological fracture. After the inflammation subsides, physical therapy and a gradual increase in load are prescribed. Self-administration of antibiotics, warming and ointments without examination by a doctor is dangerous: they blur the picture and contribute to the transition of the disease to a chronic form.
- Hospitalization for an acute process
- Long-term antibiotic therapy based on culture results
- Surgical sanitation: opening, necrectomy, drainage
- Removing or replacing infected implants
- Immobilization and unloading of the limb
- Correction of diabetes mellitus and treatment of vascular disorders
- Rehabilitation: exercise therapy, gradual restoration of support
