Osteomyelitis

Diagnosis

Healthcare provider will perform a physical examination to assess for sign of tenderness, swelling, or warmth around the affected bone. In case of a foot ulcer, the healthcare provider may use a dull probe to locate the underlying bone.
To properly diagnose osteomyelitis and determine the type of bacteria causing the infection, a combination of tests and procedures may be recommended. These may include:

• Imaging tests: The following imaging test will be recommended by the healthcare provider to diagnose osteomyelitis.
  • X-rays: X-rays can show damage to bones, but the damage may not be noticeable until osteomyelitis has been present for a few weeks. If the osteomyelitis is recent, more in-depth imaging tests may be required.
  • Magnetic resonance imaging (MRI): This procedure uses a powerful magnetic field and radio waves that produce detailed images of bones and surrounding soft tissues.
  • Computerized tomography (CT): A CT scan produces a detailed cross-sectional picture of a person’s internal anatomy by combining X-ray images from different angles. A CT scan is typically only performed if an MRI is not an option.
  • Bone scan: During an imaging scan, a bone scan uses a small amount of safe, radioactive material to detect infections or fractures in the bones.
• Blood tests: A complete blood count (CBC) is performed to check for indicators of inflammation and infection, while a blood culture is used to detect bacteria in the bloodstream. Osteomyelitis cannot be diagnosed through a blood test alone. However, blood tests can provide information that can help healthcare providers determine if further testing or medical intervention is necessary.
• Bone biopsy: The type of bacteria causing the bone infection can be identified through a bone biopsy. Knowing the type of bacteria allows healthcare providers to select an antibiotic that is highly effective for that particular infection. An open biopsy requires anesthesia and surgery to access the bone. A surgeon may occasionally insert a long needle through the skin and into the bone to obtain a fluid, tissue, or bone sample for biopsy, which may be guided by an X-ray or other imaging scans.

Treatment

Recovery from a bone infection can be a slow process. The most common treatment for osteomyelitis is surgical removal of infected or dead bone tissue, followed by intravenous antibiotics to combat the infection.

Treatment for osteomyelitis may include the following:

• Medication: A bone biopsy will determine the type of germ causing your infection, allowing your doctor to select an effective drug.
  • Antibiotic: Antibiotic are used to eliminate bacteria that cause infections. The duration of antibiotic treatment may range from four to eight weeks and may involve a combination of intravenous antibiotics in the hospital for one to two weeks, followed by oral medications for several weeks. In cases of chronic infections, months of antibiotic treatment may be necessary.
  • Antifungals: For treatment of fungal infections, oral antifungal medication may be required for an extended period of several months.
  • Pain relievers: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used to relieve pain and reduce inflammation.
    Quitting smoking can help improve the healing process. It’s also essential to effectively manage any chronic conditions, such as maintaining proper control of blood sugar levels in individuals with diabetes
• Surgery: The surgery for osteomyelitis may involve several techniques depending on the severity of the infection, including:
  • Debridement: During this procedure, a small margin of healthy bone is removed along with as much of the infected bone to ensure that all contaminated areas have been removed. Any nearby tissue that shows symptoms of infection may also be removed.
  • Drainage of infection: Expanding the area around your infected bone allows your surgeon to drain any fluid or pus that has built up in response to the infection.
  • Restore blood flow to the bone: To fill the gaps left by the debridement procedure, your surgeon may use a piece of bone or other tissue, such as skin or muscle, from another part of your body. In some cases, temporary fillers may be inserted into the area until the patient is in good health for a bone or tissue graft. The graft helps support the healing of damaged blood vessels and the formation of new bone.
  • Removal of foreign objects: Foreign objects, such as surgical screws or plates inserted during the previous operations, may need to be removed.
  • Amputation: To prevent the spread of the infection to other parts of the body, surgeons may need to amputate the affected limb.
  • Spine surgery: Patient with vertebral osteomyelitis may require spine surgery, which can prevent the collapse of vertebrae and protect the spinal cord, nerves, and other nervous system components.