Etiologic Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone, myelo- meaning marrow, and

-itis meaning inflammation) simply means an infection of the bone or bone marrow. It can be usefully subclassified on the basis of the causative organism (pyogenic bacteria or mycobacteria), the route, duration and anatomic location of the infection. 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.

Risk factors are:
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Diabetes Hemodialysis Injected drug use Poor blood supply Recent trauma

People who have had their spleen removed are also at higher risk for osteomyelitis. Symptoms
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Bone pain Fever General discomfort, uneasiness, or ill-feeling (malaise) Local swelling, redness, and warmth

Most infections in orthopaedics. surrounds the dead bone under the periosteum. In chronic osteomyelitis and implantassociated infections. are caused by biofilm-forming bacteria. .the planktonic state or the stationary state. stationary bacteria within the biofilm appear to be phenotypically different from their planktonic types. the formation of new bone. bacteria grow within biofilms attached to the surface of the dead bone or foreign material. This protective mode of growth shields bacteria from antibiotic agents and host defence mechanisms. and enables the infection to persist. and the exudation of polymorphonuclear leukocytes. including osteomyelitis. Biofilm-forming bacteria exist in 1 of 2 states . In contrast.Pathophysiology Acute osteomyelitis presents as a suppurative infection accompanied by oedema. and are thereby less susceptible to the effects of chemotherapeutic agents. an involucrum. and prevention of chronic orthopaedic infection. New bone forms from the surviving fragments of periosteum and endosteum in the region of the infection. the vascular supply to the bone is decreased by infection extending into the surrounding soft tissue. In an established infection. Planktonic bacteria are free-floating. Large areas of dead bone (sequestra) may be formed when the medullary and periosteal blood supplies are compromised. Pathological features of chronic osteomyelitis are the presence of necrotic bone. The involucrum is irregular and is often perforated by openings through which purulence may track into the surrounding soft tissue and eventually drain to the skin surface. vascular congestion. the body’s host defences can easily eradicate the organism through the usual immunological mechanisms. In early acute disease. The concept of biofilm science must be applied to the diagnosis. They have a slower rate of growth and are less metabolically active. communicate through cell-cell signals. and adhere to an inert or living surface. A biofilm is a highly structured community of bacterial cells that adopt a distinct phenotype. Acute osteomyelitis can be arrested before dead bone develops if treated promptly and aggressively with antibiotics and surgery (if necessary). An encasing sheath of live bone. treatment. and small-vessel thrombosis. fibrous tissue and chronic inflammatory cells form around the granulation tissue and dead bone. forming a chronic sinus.

Often. or longer. If there are metal plates near the infection. may need surgery to remove the prosthesis and infected tissue around the area. . Antibiotics are taken for at least 4 .6 weeks. Infection of an orthopedic prosthesis. doctors wait to implant the prosthesis until the infection has gone away. the antibiotics are given through an IV (intravenously) rather than by mouth. such as an artificial joint.Diagnosis A physical examination shows bone tenderness and possibly swelling and redness. Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. More often. 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. You may receive more than one antibiotic at a time. Antibiotics are given to destroy the bacteria causing the infection. Tests may include:          Blood cultures Bone biopsy (which is then cultured) Bone scan Bone x-ray Complete blood count (CBC) C-reactive protein (CRP) Erythrocyte sedimentation rate (ESR) MRI of the bone Needle aspiration of the area around affected bones Management Treatment-The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues. they may need to be removed. A new prosthesis may be implanted in the same operation.

such as the foot. surgery to improve blood flow may be needed. pus is produced in the bone. This chronic infection can cause symptoms that come and go for years. The lost blood supply can result in a complication called chronic osteomyelitis. The abscess steals the bone's blood supply. People who are at high risk or who have a compromised immune system should see a health care provider promptly if they have signs of an infection anywhere in the body. Complications When the bone is infected. which may result in an abscess. If there are problems with blood supply to the infected area.If you have diabetes. Other complications include:    Need for amputation Reduced limb or joint function Spread of infection to surrounding tissues or the bloodstream . it will need to be well controlled. Prevention-Prompt and complete treatment of infections is helpful.