What Is Osteomyelitis?
Osteomyelitis is a bone infection caused by bacteria or fungi. The bacteria and fungi circulate in the bloodstream and then settle in the bone where they multiply, or they can enter the bone from a nearby open wound. Osteomyelitis can occur due to an open fracture, in which bone pokes through the skin.
This condition can cause severe pain, inflammation, and swelling. It can usually be treated with antibiotics, but if left untreated, it may cut off blood supply to the bone, causing it to die.
Symptoms vary depending on the type of osteomyelitis. Some of the most common symptoms include:
- Pain at site
- Redness, tenderness, and swelling at the site
- Lethargy or fatigue
- Fever, chills, and sweating
- Malaise (general feeling of being unwell)
- Drainage of pus from the wound
Anyone can develop osteomyelitis. However, senior citizens, people with other medical conditions, and children younger than three are more likely to have osteomyelitis.
Types of Osteomyelitis
There are several types of osteomyelitis:
- Acute - Acute osteomyelitis occurs suddenly and will show in diagnostic tests or procedures about two weeks after infection. This type of osteomyelitis is usually easier to treat. However, if left untreated, it can progress into chronic osteomyelitis.
- Chronic - Chronic osteomyelitis typically occurs after a bout of acute osteomyelitis is not entirely cured. This type can result in dead bone and bone destruction if left untreated.
- Hematogenous - An infection in the blood causes this type of osteomyelitis. Hematogenous osteomyelitis occurs more often in children than adults. In children, it typically involves long bones, particularly the femur and tibia. In adults, it’s usually found in the vertebral bodies (spine), long bones (such as in the arms and legs), pelvis, or clavicle (collarbone). Many patients with hematogenous osteomyelitis have underlying chronic diseases. Hematogenous osteomyelitis can be acute or chronic.
- Vertebral - Occurring most often in older patients, vertebral osteomyelitis — also referred to as spinal osteomyelitis or spondylodiscitis — affects the spine. It can occur after a spinal injury or spinal surgery or may spread into the bloodstream from another body area. Vertebral osteomyelitis can be acute or chronic.
- Diabetic foot osteomyelitis - People with diabetes may develop osteomyelitis of the foot. This occurs when soft tissue becomes infected. This infection then spreads into the bone.
Osteomyelitis Signs & Symptoms
The specific signs and symptoms of osteomyelitis will vary depending on the type of condition:
- Acute - Acute osteomyelitis often presents with a fever, followed by pain in the affected area a few days later. Symptoms can include nausea, malaise, chills and sweating, irritability, fatigue, swollen, tender, or red skin at the site, and loss of range of motion. If the infection spreads to the muscle or skin, abscesses may form, resulting in drainage of pus through the skin.
- Chronic - Chronic osteomyelitis is often characterized by deep bone pain and symptoms similar to those of acute osteomyelitis: nausea, malaise, fevers, chills, and sweating, as well as swollen, tender, or red skin at the site. Abscesses can form if the infection has spread to the muscle or skin, causing drainage of pus through the skin. Bone destruction and formation of dead bone can occur with chronic osteomyelitis. Rarely this type of osteomyelitis can occur without symptoms.
- Hematogenous - In children, this bloodborne type of osteomyelitis typically presents with chills, pain, and signs of inflammation in the infected area. Patients may also exhibit a limited range of motion or limping. Adults may exhibit chills, dull pain, swelling, and warmth in the infected area. If the infection spreads to the muscle or skin, forming abscesses, pus may drain through the skin. With hematogenous osteomyelitis especially, a high fever may be present.
- Vertebral - Because vertebral osteomyelitis affects the spine, it can cause chronic back pain that worsens when one moves around. Other symptoms include weakness, weight loss, numbness, and tingling; abscesses can also occur, causing drainage of pus in the affected area. Patients with vertebral osteomyelitis often have pain but no other symptoms. Treatments like pain relievers, heating pads, and rest typically don’t do much to provide relief. This type of osteomyelitis occurs most often in older patients.
- Diabetic foot osteomyelitis - In patients who develop osteomyelitis of the foot due to a diabetic foot infection, symptoms may include bone pain, malaise, swelling, redness, or warmth in the affected area, as well as fever, sweating, and chills. If there is an open wound, drainage of pus may occur. Such infections may result in osteomyelitis of the toe or ankle.
General osteomyelitis symptoms
The following symptoms may present across all types of osteomyelitis:
- Pain at the site that becomes worse when pressing on the affected area or standing
- Deep bone pain
- Swelling, redness, and tenderness at the site
- Fever, chills, and sweating
- Drainage of pus from wounds or abscesses
- Loss of appetite
- Irritability (especially in infants who can’t express pain)
Osteomyelitis can permanently damage bone and surrounding tissues and muscles, leading to chronic osteomyelitis. Fractures to the affected bone may occur. If the infection has spread to the tissues and muscles, abscesses — or pockets of pus — can end up seeping through the skin. People with chronic osteomyelitis can experience recurring abscesses, which may require professional draining. In children still growing, osteomyelitis can stunt bone growth.
Bone death (osteonecrosis) can occur if the swelling worsens to the point that it cuts off blood flow to the bone. Necrosis of the bone can lead to gangrene, which in turn can quickly cause sepsis, a severe infection of the blood. In very rare cases, this can result in amputation or loss of limb. In extreme untreated cases, life-threatening osteomyelitis complications can occur.
What Causes Osteomyelitis?
Osteomyelitis occurs when bacteria or fungi from the blood or a nearby tissue infect the bone. The most common osteomyelitis causes are:
- An open fracture, in which the bone pokes through the skin
- An injury, surgery, illness, or fracture that damages the skin near or over a bone
- Infected tissue, prosthetic joint, or metal implant post-injury or post-surgery
- Open wounds
The bacteria Staphylococcus aureus, which causes staph infections, often causes the initial infection.
Osteomyelitis Risk Factors
Affecting 2 to 5 in every 10,000 people, osteomyelitis is considered rare. It is more common in people who have recently sustained an injury or undergone surgery and those with weakened immune systems.
The risk of osteomyelitis is higher if a person has:
- Blood infection or condition, like sickle cell anemia
- Diabetes, in particular, diabetes-related foot ulcer
- Weakened immune system, for example, due to viruses like HIV
- Recent broken or fractured bone
- Recent bone surgery
- Traumatic injury or wound
- Metal implants in bone, such as plates or screws
- Artificial joints, such as a hip replacement
- Intravenous drug use, such as heroin
- Pressure injuries, such as bedsores
- A habit of smoking
Trust NewYork-Presbyterian for Your Osteomyelitis Treatment
The experts at NewYork-Presbyterian Columbia Orthopedics have years of experience treating all types of osteomyelitis in children and adults. Our dedicated medical team will work closely with you or your child to assess symptoms, discuss your options, and create a personalized treatment plan to minimize pain and prevent further bone loss or damage caused by osteomyelitis.