Osteomyelitis

Overview

Osteomyelitis is an infection of the bone. It happens when bacteria (germs) get into a bone and cause swelling, pain, and damage. It needs medical treatment right away to prevent serious problems.

Osteomyelitis is rare. It affects about 2 in 10,000 people each year, but it is more common in people with certain health conditions like diabetes or a weakened immune system.

It can affect anyone, but it is more common in children and older adults. People with diabetes, poor blood flow, or who have had a recent injury or surgery are also at higher risk.

Symptoms

Common symptoms

• Deep bone pain that gets worse over time
• Swelling, warmth, and redness over the affected bone
• Fever and chills or sweating
• Nausea or feeling generally unwell

Symptoms in children

• Irritability or seeming tired or fussy
• Refusing to walk or limping
• Fever without an obvious cause
• Tenderness or pain when touching the affected area

Symptoms in older adults

• A sudden change in ability to walk or move a limb
• Mild pain or stiffness that is easy to dismiss
• Confusion or feeling more confused than usual
• A low-grade fever that does not get better

Causes

Main causes

• Bacteria entering the bone through a deep cut, wound, or surgical incision
• Bacteria spreading through the bloodstream from another infection, such as a urine infection or infected skin sore
• A recent broken bone, joint replacement, or other orthopedic surgery that gives bacteria a chance to reach the bone

Risk factors

• Diabetes with foot ulcers or poor blood flow
• Peripheral artery disease (narrowing of blood vessels in the legs)
• Recent injury, fracture, or surgery, especially joint replacement
• Intravenous drug use, as needles can carry bacteria into the bloodstream
• A weakened immune system from illness or medicines
• Sickle cell disease or other blood disorders

When to see a doctor

See a doctor urgently if:

• If you have sudden severe pain and swelling over a bone, or you cannot move the area normally
• If you have a fever and bone pain together
• If a wound or sore becomes very painful, red, or starts draining

Book a routine appointment if:

• If you have had persistent bone pain or swelling for more than a few days that is not getting better
• If you have diabetes and you have a foot wound that is not healing
• If you have had an orthopedic operation and you are worried about the area

Diagnosis

A doctor will ask about your symptoms and recent injuries or operations. They will examine you and feel the area. They will also order tests. If osteomyelitis is suspected, you will usually be referred to a specialist or an emergency department.

Tests that may be done

• Blood tests to check for a high level of infection markers and to grow bacteria from your blood
• X-rays to look for bone changes, though these may not show early infection
• MRI (magnetic resonance imaging) scan, which gives detailed pictures of bone and can show infection clearly
• Bone biopsy – a small sample of bone taken with a needle to identify the exact bacteria and guide treatment

What to expect at your appointment

The diagnosis is not always easy. Many conditions look like osteomyelitis. You may need to give several blood samples and have more than one scan. If you are admitted to hospital, you may be seen by an orthopedic surgeon (bone specialist) and an infection specialist.

Treatment

Osteomyelitis is treated with a long course of antibiotics and, in some cases, surgery to remove infected and dead bone. You will usually start antibiotics through a drip (IV) in a vein while you are in hospital, and later switch to tablets you take at home. The whole course often lasts anywhere from 4 to 6 weeks, but for chronic infections it can be longer.

Self-care at home

• Rest the affected limb and keep it elevated when sitting or lying down
• Take pain relief exactly as your doctor or pharmacist advises – ask them what is safe for you
• Follow any wound care instructions carefully, especially for diabetic foot wounds
• Keep the area clean and dry, but do not soak it

Medical treatments

The main medical treatment is antibiotics, given through a vein or as tablets. The choice and length of antibiotics depend on the bacteria causing the infection, your general health, and how severe the infection is. For severe or chronic infections, you may need to be in hospital for part of the treatment. Sometimes a specialist will recommend surgery to drain an abscess (a collection of pus) or to remove necrotic (dead) bone.

When is surgery considered?

Surgery may be needed if there is an abscess in the bone, if dead bone needs to be removed, or if there is a foreign device like a metal plate that keeps getting reinfected.

Living with this condition

If you are on antibiotics at home, you will need to follow the schedule very strictly and finish the whole course, even if you feel better. You may need daily visits from a community nurse if you are having IV antibiotics at home. You will also have regular check-ups and maybe repeat scans to make sure the infection is going.

Lifestyle tips

• Do not smoke, as smoking slows bone healing and reduces blood flow
• If you have diabetes, keep your blood sugar under good control because high blood sugar makes infection worse
• Keep all appointments with your bone specialist and infection team
• Tell your healthcare team about any new pain, swelling, fever, or wound drainage

Diet and exercise

Eat a balanced diet rich in protein, calcium, and vitamin D, which help bones heal. Gentle movement can help keep your joints flexible while you recover, but follow your doctor's advice about how much weight to put on the affected bone. Physiotherapy may be offered later to help you regain strength.

Mental health and emotional wellbeing

A prolonged infection and antibiotics can be stressful and make you feel tired and low. It is normal to have days when you feel frustrated or anxious. Talk to your healthcare team about how you are feeling; they can point you to support services.

Prevention

You can reduce your chances of osteomyelitis by taking good care of your skin, especially if you have diabetes. Clean cuts and scrapes right away, watch for signs of infection, and do not ignore a wound that is not healing. If you have a foot problem, check your feet daily.

Vaccines

Keeping your vaccinations up to date can help prevent some infections that can spread to bone, such as pneumococcal disease. Ask your doctor which vaccines are right for you.

Screening programmes

If you have a condition that raises your risk, like diabetes or peripheral artery disease, your doctor may recommend regular foot check-ups to catch problems early. That is a form of screening.

Complications

If left untreated

• The infection can spread to nearby joints, causing septic arthritis (a serious joint infection)
• Dead bone can form, creating a chronic infection that is very hard to cure
• Bacteria can enter the bloodstream and cause sepsis, a life-threatening whole-body infection
• In children, the infection can damage the growth plate and affect future bone growth

Long-term outlook

With early treatment, most people with osteomyelitis recover completely. Even in chronic cases, specialists can often control or cure the infection with a combination of surgery and antibiotics. Recovery takes time, but the prospects are good if you stick to your treatment plan.

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