Osteomyelitis is an infection of the bone. It is more common in children due to a rich metaphyseal blood supply and an underdeveloped immune system. It affects 1 in 5,000 children under 13 years of age. Patients with osteomyelitis often present with limb pain, a limp or a hesitancy to bear weight, and sometimes a fever or chills. The patient may also not experience any symptoms.
Osteomyelitis is caused by a bacterial infection. The bacteria can enter the bone through the bloodstream, from an adjacent injection, or from direct contamination, such as a serious injury that exposes the bone or during surgery.
Bone infections that are not properly addressed can cause serious complications, including:
- Osteonecrosis (bone death)
- Joint arthritis
- Growth impairment
Diagnosis of osteomyelitis is usually confirmed via imaging (i.e. x-rays) and blood tests. X-rays can reveal bone damage, but this is usually only visible when the infection has been present for some time. Computerized tomography (CT) scans and magnetic resonance imaging (MRI) may also be ordered. CT scans, like x-rays, can reveal changes to the bone structure. An MRI may reveal marrow and soft tissue edema. Blood tests will also be ordered if infection is suspected. Increased levels of white blood cells and other blood factors may indicate the presence of infection. Treatment involves administering antibodies to combat the infection and surgery to remove any infected bone or soft tissues.
Treatment for osteomyelitis includes non-operative and operative techniques. Non-operative treatment includes administering antibodies to combat the infection. Antibiotic treatment requires knowledge on the type of bacteria causing the infection. This can be determined using a biopsy, a minimally invasive procedure that involves inserting a needle into the bone. A bone culture is obtained which can reveal the type of bacterial infection, which in turn will determine the appropriate antibody.
Surgical treatment may be necessary if the patient does not respond to antibiotic treatment. Other indications for surgery include chronic infections or the presence of significant necrotic (dead) bone.
The first step to surgery is to expose the infected bone and surrounding soft tissues and drain any fluid or pus that is present. The next step is to remove any infected bone and soft tissue, a process called debridement. The final step is to apply a bone graft. This will induce new bone to grow in place of the excised necrotic bone.
In cases where there is a large amount of necrotic bone, additional surgical treatment is necessary. When large amounts of bone are removed, this results in a bone defect. At the Paley Institute, we have treated many complicated bone defect cases through a technique known as bone transport.