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OSTEOMYELITIS

What is Osteomyelitis ?

Osteomyelitis is a condition in wich bone becomes infected by bacteria. It is more common in children, where it may appear to occur for no apparent reason, or follow an infection which has spread from elsewhere in the body. In adults, it usually occurs following a fracture, where the skin is also damaged, and the bones exposed. In children, the first symptom is usually pain. Sometimes a lump is present, if one of the leg bones is affected. The child may become generally well, with a temperature. Later there may be redness or swelling over the bone. If untreated, an abscess may form, which eventually bursts, discharging pus. Following a fracture, the area around the affected bone may become painful, red and swollen. There may also be a discharge of pus from the wound connected with the fracture. If the infection is inadequately controlled in the early stages, it may result in chronic osteomyelitis.

How does Osteomyelitis occur ?

In children it is thought that bacteria enter the bloodstream through the nose or bowel, and settle in areas of the bone which have been previously damaged by a small knock, or in parts of the bone with a good blood supply. The bacteria multiply and the body's defences cause pus to form. This eats away the bone and an abscess forms which spreads through the bone and eventually comes to the surface. After a fracture, the bacteria enter the wound directly and settle on the bare ends. They then multiply and cause pus to form which eventually discharges back through the wound. In some people, the infection may start in another organ, such as the lung. From here, the germs can spread throught the bloodstream into bone. People with diabetes are particularly prone to infection. If an ulcer develops on the toe or foot, it is not uncommon for the germs responsible to sooner or later penetrate through to the underlying bone. The symptoms in this case may be quite inapparent, and only some swelling may be noticed.

Why does Osteomyelitis occur ?

In some children, especially the newborn, the bacteria may enter the bloodstream after blood tests or an intravenous drip feed. In other children, such as those who have sickle cell disease of the blood, damage to the bone as a result of the disease makes it more liable to become infected. In adults with diabetes, the reduced resistance to infection, poor blood circulation and a frequent loss of pain sensation all lead to a particularly insidious and ofen chronic osteomyelitis.

Treatment Involved for Osteomyelitis

Blood tests are taken to look for signs of infection and to identify the germ, x-rays of the affected limb may be helpful if bone has been damaged. However, in the very early stages there may be no abnormalities on x-rays. In early osteomyelitis, treatment with antibiotics into a vein may alone be effective. Even when the temperature and pain has settled, they will need to be continued for 3 to 6 weeks by mouth. Once the infection is established, any pus in the bone may have to be drained. This requires an operation under general anaesthetic. Once this is done, antibiotics will be given by drip infusion into a vein. In more severe or chronic cases, an operation may be necessary to remove dead bone, which occurred as a result either of the fracture or of the infection. If a previous fracture has been fixed with metal plates or screws, these will be removed. The operation may require a bone graft from the hip to fill the cavity which is left, and the limb may have to be rested in plaster.

During Treatment for Osteomyelitis

In the early stages of osteomyelitis in children, the child will be in hospital and will be observed to ensure that the antibiotic treatment is effective and that the infection is being adequately controlled. After discharge from hospital, recurrence of pain and any signs of swelling or redness in the affected limb, another limb, or area close to the bone should be notified to the doctor. The full course of antibiotics must be taken as prescribed, to prevent the infection returning. After surgical drainage of bone infection in either children or adults, the area of drainage should be watched for any change in the discharge from the wound or from holes (sinuses) close to the wound. Should this happen, contact your doctor.

After Treatment for Osteomyelitis

In the majority of children, after adequate treatment with antibiotics and/or surgery, the infection settles completely and does not recur. Any change in the affected limb or other limbs should be watched for and your doctor contacted immediately if anything is noted. In chronic osteomyelitis, especially in adults after fractures, there may be recurring discharge from the region of the damaged bone. Intervals of several years may separate each event. Redness and swelling near the old fracture will often settle quite quickly with antibiotic treatment if recognized and treated early, but may need operation if left too long.

If Osteomyelitis is Left Untreated

Acute osteomyelitis untreated in children is a severe, life-threatening condition. Those children who survive will develop an infection which involves the whole bone, leading to its destruction, discharge of pus from the limb and chronic osteomyelitis. If the infection affects bone close to a joint such as the hip joint, the infection may discharge into the joint which will cause destruction and damage to the joint if left untreated. This damages the growing areas of the bone, resulting in growth ceasing and a short limb. Damage to the joint may result in dislocation or stiffening. Rarely, in chronic osteomyelitis, the repeated discharge of pus from a hole (sinus) communicating with the bone will irritate the skin and lead to a rare form of skin cancer.

Effects on Family of Osteomyelitis

Children with acute osteomyelitis need support from the family whilst in hospital, with help and encouragement after discharge in taking the medication as prescribed, and continuing it in the absence of symptoms. In chronic osteomyelitis or in children with growth disturbance as a result of the infection, a lot of help is required. The child with a short limb or dislocated hip may require many further operations, special surgical appliances and psychological support to cope with his disability. Discharging sinuses are socially unacceptable as they smell and require repeated dressings. Help is needed to cope with this disabling condition.