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What is Osteomyelitis
Osteomyelitis is an infection involving
the bone caused by various
microorganisms such as bacteria and
fungi. These organisms can infect the
bones in several ways:
1-through the bloodstream from other
infected areas of the body
2-injury – bacteria enter the bone
through a traumatic wound
3-direct extension – spread to the bone
from an adjacent wound or infection
Although the most common bacterial
pathogens are species of Staphylococcus
and Pseudomonas, it is important to
identify the organism(s) responsible for
each individual osteomyelitis infection.
To do this, the infected tissues are
sampled (biopsied) and incubated in the
laboratory to grow as living cultures.
The organisms are then identified
according to their growth
characteristics and appearance under the
microscope. Once identified, they are
tested for their sensitivity to various
antibiotics.
The safest,
most-efficient agent is chosen for
delivery to the patient. Antibiotics are
given by mouth (PO) as pills or liquids,
by vein (IV) or by a direct application
into the wound as a depot (antibiotic
beads, gels, ointments, patches or
suppositories).
In some
instances, osteomyelitis can persist to
become chronic due to the presence of
injured tissue and foreign material
within the wound.
Where Do These
Organisms Come From?
Organisms gain
access to the bone either by direct
inoculation or are carried by the blood
stream from some other site of
infection. Traumatic inoculations
(gunshot wounds, compound fractures,
open surgery, etc.) account for a large
percentage of the osteomyelitis cases
seen at our center.
Classifications
of Osteomyelitis
Osteomyelitis is
classified according to what parts of
the bone are involved in the disease
(Types I - IV in figure below) and the
health of the patient. Based on medical
history, patients are classified as
either compromised (B-Hosts) or
uncompromised (A-Hosts). Compromised
patients have decreased healing
potential when compared to uncompromised
patients. Conditions which may classify
you as a compromised healer include:
Diabetes
Use of steroids
Poor
nutrition
Extensive scarring
Use
of tobacco products
Cancer
Previous radiation therapy
Organ
failure
Chronic lymphedema
Old age
Tobacco use (smoking, in particular) is
the most common compromising factor in
patients treated for Osteomyelitis. With
failures ranging from 30 to 100 percent
in many protocols, the use of tobacco
products during treatment may make the
difference between limb salvage and
amputation.
The classification
(staging) of your bone infection is
formulated by combining the type of
disease with the host class (i.e., Stage
IVB). As in the field of oncology, the
clinical staging of osteomyelitis is
used to direct therapy and predict a
successful outcome. It also allows the
comparison of patient cohorts to
evaluate the effectiveness of various
treatment methods.
If you need
treatment for the bone infection
osteomyelitis or any infection of the
musculoskeletal system, our San Diego
surgeons, who serve patients from Mexico
and across the globe, can help you make
the right decision. We want to give you
the greatest potential for complete and
successful healing. If you are
interested in an Internet screening
consultation,
Misunderstandings about Osteomyelitis
MYTH: The infection will continue to
spread in the bone and eventually to the
rest of my body.
FACT: Generally,
osteomyelitis does not spread to other
parts of your body because these other
tissues are alive, have a blood supply,
and are protected by your immune system.
An exception to this is when there are
artificial joints in other parts of your
body. In these instances, the "foreign
bodies" are vulnerable to circulating
pathogens. In general, treatment of your
bone infection is not an emergency. Your
body's protective mechanisms will
usually keep the infection localized to
the original site.
MYTH: The
infection will make other people sick if
they come into contact with me.
FACT:
Your bone infection is usually not
contagious and will not affect other
people unless they are severely
compromised. Good hand-washing practices
(when you change dressings) and a clean
dressing (over open wounds) should be
enough to keep everyone protected.
MYTH: You or your doctor must have
done something wrong for an infection to
develop.
FACT: In most cases, no one
is to blame. The type of injury or
fracture may increase your chance of
infection, as may your medical health.
Some factors can be changed and thereby
reduce your risk, but many can not.
Tobacco use is the easiest to change.
MYTH: Antibiotics do not work in my
body.
FACT: Antibiotics work so long
as the organisms are vulnerable and the
antibiotics are appropriately selected,
administered, and regulated. However,
antibiotics are usually not effective
against organisms attached to dead bone
and foreign-body surfaces (i.e., to
wood, metal, plastic, etc.). The most
efficient way to treat a chronic bone
infection is to combine a thorough,
surgical debridement with appropriate,
antibiotic agents.
MYTH: Because
my leg was once infected, I cannot have
an operation to fix a bone deformity and
restore function.
FACT: With proper
staging and surgical planning, the
success rate for a reconstruction at a
previously infected site is 95 percent.
MYTH: The only way to cure chronic
osteomyelitis is with an amputation.
FACT: This statement was true back in
the 70s, but not today. It is very rare
for amputation to be the treatment plan
of choice for patients with chronic
osteomyelitis.
The knowledge
gained through years of treating
patients has enabled me to anticipate
many of your questions and fears. Our
goal is to return you to a normal life,
free from osteomyelitis and other types
of infections. Although your extremity
may never be the same as it was prior to
injury, we will strive to return as much
function and mobility as possible.
MYTH: My doctor tells me he has done
everything that can be done and I will
be wasting my time and money to try
again.
FACT: Experience is everything
when treating chronic osteomyelitis
infections. The two-year success rate
for 2,500 plus patients treated in our
centers is over 94 percent. Yet, even
with this vast experience, our
techniques and methods continue to
evolve.
There are several
types of treatment for osteomyelitis and
similar bone infections, including:
Free Tissue Transfers
Bone Grafts
Antibiotic Beads
External Fixators
Ilizarov
Amputations
Hyperbaric Oxygen Therapy
Determining
the Course of Treatment
During the
treatment process, you will be expected
to be an active partner. A surgical
treatment plan and statistical chance
for a cure will be discussed with you
prior to beginning treatment. Treatment
may be complex and plans may be altered
along the way to ensure your safety and
a good outcome. Our goal is to return as
much function and. form to your
extremity as possible. Prior to
beginning treatment, it is imperative we
know your complete medical history and
you have listed your allergies and
medical conditions; if compromising
factors (co-morbidities) exist that can
affect your outcome, many can be
reversed prior to treatment to improve
your treatment options and chance for
cure - the selection of methods is based
on specific host and wound parameters .
The basic treatment involves the
following:
Debridement: All
infected, and compromised tissues are
surgically excised, including skin,
muscle, tendon, ligaments, and bone.
Foreign bodies and surgical implants are
removed.
Rest: The tissues must rest
and recover under the protection of good
nutrition, antibiotics, and adequate
blood flow.
Reconstruction: When the
debrided would has healed, form and
function can safely be restored using
any and all orthopedic techniques.
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