OSTEOMYELITIS

Infection of the bone, most commonly caused by Staphylococcus

Aureus. It can be either acute or chronic.

OTHER NAME

Hematogenous Osteomyelitis

TYPES

There are three main types of osteomyelitis:

• Acute osteomyelitis - bone infection develops within two

weeks of an initial infection, injury or the onset of an underlying
disease.
• Sub-acute osteomyelitis - bone infection develops within
one or two months of an initial infection, injury or onset of an
underlying disease.
• Chronic osteomyelitis - bone infection develops two months
or more after an initial infection, injury or onset of an underlying
disease.

CAUSES

Bone infection can be caused by bacteria (more common) or fungi (less

common).
• Infection may spread to a bone from infected skin, muscles, or
tendons next to the bone, as in osteomyelitis that occurs under a
chronic skin ulcer (sore).
• The infection that causes osteomyelitis can also start in another
part of the body and spread to the bone through the blood.
• A current or past injury may have made the affected bone more
likely to develop the infection. A bone infection can also start after
bone surgery, especially if the surgery is done after an injury or if
metal rods or plates are placed in the bone.

STAGES OF OSTEOMYELITIS
RISK FACTORS

• Trauma
• Diabetes
• Injected drug use
• Hemodialysis
• Old age
- ↓Immune function
• Poor circulation

SIGNS AND SYMPTOMS

• Pain and/or tenderness in the infected area

• Swelling and warmth over the infected area
• Fever
• General discomfort, uneasiness, or ill feeling
• Drainage of pus through the skin

Additional symptoms that may be associated with this disease include:

• Excessive sweating
• Chills
• Lower back pain (if the spine is involved)
• Swelling of the ankles, feet, and legs
• Changes in gait (walking pattern that is a painful, yielding a limp)

PATHOPHYSIOLOGY

Predisposing factors:
• vascular insufficiency
disorders
• genitourinary infections
• respiratory infections
• IV drug use
• Immune-compromising
diseases
• history of blood- stream

Open
wounds/fractures

Microorganisms lodge into an

area where circulation slows

Microorganisms
grow
 Increase
pressure

Ischemia Vascular
compromise

Infection through the

bone cortex and

Ischemia of the
periosteum

Cortical
devascularization

Necrosis

Formation of new Sequestr Separation of

bone devitalized
bone from living bone

Involucrum Continues to be an infected

island

Difficulty to reach by blood borne

antibiotics

Chronic Stage Enlarged

sequestrum

Development of sinus Sequestrum move

tract out to the soft
tissue

Turns to scar Revascularize

tissue d
Site for continued Removal by the
microorganism growth normal
immune process

Remission and Healing

exacerbation
 Excessive
Loss of organ Amputation
vascular
DIAGNOSTIC EXAM function
insufficiency

• CBC- WBC may be elevated (indicates presence of active infection).

• ESR (erythrocyte sedimentation rate) - may be elevated (indicates
inflammatory process).
• Bone Scan (indicates infected bone).
• Bone lesion biopsy or culture (may reveal the causative organism).
• Needle aspiration of the area around affected bones
• MRI of the bone

TREATMENT AND MANAGEMENT

The goal of treatment is to get rid of the infection and reduce damage to
the bone and surrounding tissues.

• Analgesics as prescribed.

• Antibiotics as prescribes.

• Dressing changes - use sterile technique.

• Maintain proper body alignment and change position frequently to

prevent deformities.

• Immobilization of the affected part.

Surgery may be needed to remove dead bone tissue if you have an
infection that does not go away.

• Incision and Drainage of bone abscess.

• Sequestrectomy- removal of dead, infected bone and cartilage.

• Bone grafting is recommended after repeated infections.

If there are metal plates near the infection, they may need to be
removed. The open space left by the removed bone tissue may be filled
with bone graft or packing material that promotes the growth of new bone
tissue.

PREVENTION

• Elective orthopedic surgery should be postponed if the patient has a

current infection (like urinary tract infection, sore throat) or a recent
history of infection.

• During orthopedic surgery, careful attention is paid to the surgical

environment and to techniques to decrease direct bone contamination.

• Prophylactic antibiotics- administered to achieve adequate tissue

levels at the time of surgery and for 24 hours after surgery.
 • Urinary catheters and drains are removed as soon as possible to
decrease the incidence of hematogenous spread of infection.

• Aseptic postoperative wound care reduces the incidence of superficial

infections and osteomyelitis.

• When patients who had joint replacement surgery undergo dental

procedures or other invasive procedure, prophylactic antibiotic are
frequently recommended.

COMPLICATION

• Necrosis
• Blood clots
• Sequestra (A piece of necrotic tissue, usually bone, which has become
separated from the surrounding healthy tissue).
• Bone abscess
• Need for amputation
• Reduced limb or joint function
• Spread of infection to surrounding tissues or the bloodstream

REFERENCES:

1. Brunner and Suddarth’s Textbook of Medical Surgical Nursing pp.

2064-2067

2. Professional Guide to Diseases (Eighth Edition), 2005

3. http://www.nlm.nih.gov/medlineplus/ency/article/000437.htm

4. http://www.wrongdiagnosis.com/o/osteomyelitis/intro.htm

ILLUSTRATION