Osteomyelitis: Bone Infection

What osteomyelitis is

Bone is living tissue served by its own blood vessels, and like other tissue it can become infected. Osteomyelitis describes infection established in the bone and the marrow space inside it. Organisms can reach bone through the bloodstream from elsewhere in the body, by spreading inward from infection in adjacent soft tissue, or by direct entry when an injury opens the bone to the outside, as with an open fracture.

Infection in bone behaves differently from infection in soft tissue. Bone has a rigid structure, so swelling within it can compress the small vessels supplying it. When a segment of bone loses its blood supply it may die, and dead bone is difficult for the body's defenses and for medication to reach. Surgeons distinguish acute infection from chronic infection, which is longstanding and may involve dead bone, scarring or a persistent drainage tract. Infection can also settle around hardware placed at an earlier operation. Circumstances recognized as increasing susceptibility include diabetes, smoking, kidney disease, poor circulation, reduced immune function and open wounds such as foot ulcers. None of these means an infection is present, and none can substitute for examination and testing.

Symptoms that often bring people in

• Deep, persistent pain in a bone, sometimes worse at night or at rest
• Redness, warmth or swelling over an area of bone
• Fever, chills or a general feeling of being unwell
• Drainage or a wound near a bone, or near a previous operation
• Pain around an old fracture or implant that had previously settled down

How bone infection is evaluated

Because these findings accompany many other conditions, evaluation is directed at confirming whether infection is present, where it sits and what is causing it. History and examination come first, with attention to previous injuries, operations and wounds. Blood tests may be used to look for markers of inflammation. Imaging often begins with X-rays, though changes in bone take time to become visible, and MRI, CT or nuclear imaging may add information about the extent of involvement. Identifying the organism generally requires a sample of tissue or fluid for culture. Care is frequently shared with infectious disease specialists.

Treatment approaches in general terms

Treatment is individualized, depending on whether the infection is acute or chronic, which bone is involved, whether dead bone or hardware is present, and the person's overall health.

• Medical treatment. Antimicrobial therapy chosen according to culture results and usually planned with an infectious disease physician, along with management of contributing conditions.
• Surgical treatment. Procedures to obtain samples, drain infected fluid, remove dead or infected tissue, manage the space that remains, and where needed address hardware or reconstruct lost bone.

Treatment is described more fully on our page covering the treatment of osteomyelitis and septic arthritis. Where infection has interfered with fracture healing, see also nonunion.

What to expect when you consult Dr. Wolfson

Dr. Wolfson trained in the Ilizarov method of limb lengthening and reconstruction, an approach developed in the setting of bone infection and bone loss, and his practice includes patients with infection following trauma or previous surgery. A consultation typically involves reviewing your history and imaging in full, discussing what further testing may be needed, and explaining how orthopedic and infectious disease care are coordinated.

This page provides general information about osteomyelitis and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]