Osteomyelitis
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Osteomyelitis is an infection and inflammation of bone, usually bacterial. It can arise through the bloodstream, spread from nearby infected tissue or an ulcer, or direct contamination after trauma or surgery. It may be acute or chronic and can require prolonged antibiotics plus drainage or removal of infected/dead bone.
Topics I can cover:
- Causes and risk factors
- Acute vs chronic osteomyelitis
- Symptoms and clinical features
- Diagnosis: blood tests, cultures, X-ray, MRI
- Treatment: antibiotics, surgery, duration
- Diabetic-foot and vertebral osteomyelitis
- Complications and prevention
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Reading File
- Definition and pathogenesis - how bone becomes infected and how acute disease progresses to chronic infection.
- Causes and risk factors - bloodstream infection, trauma/surgery, contiguous spread, diabetes, vascular disease, ulcers, and immunosuppression.
- Clinical features - symptoms and signs in acute, chronic, vertebral, and diabetic-foot disease.
- Microbiology - common pathogens and how they vary by age, route, and setting.
- Diagnosis - inflammatory markers, blood and bone cultures, X-ray, MRI, nuclear imaging, and biopsy.
- Treatment principles - cultures before antibiotics when feasible, empiric then targeted antimicrobial therapy, route and duration.
- Surgery and source control - drainage, debridement, removal of necrotic bone or infected hardware, stabilization, and reconstruction.
- Special forms - hematogenous osteomyelitis in children, vertebral osteomyelitis, diabetic-foot osteomyelitis, post-traumatic/device-associated infection, and chronic osteomyelitis.
- Complications, follow-up, and prevention - sepsis, abscess, sinus tracts, fracture, recurrence, wound and foot care.
Osteomyelitis is a bone infection, most often caused by Staphylococcus aureus. Infection reaches bone through the bloodstream, direct inoculation after trauma or surgery, or extension from a nearby wound, especially a diabetic foot ulcer. Poor blood supply and devitalized bone make infection harder to eradicate.
The diagnosis relies on clinical context, inflammatory markers and cultures, with MRI generally the most sensitive imaging test for defining marrow and soft-tissue involvement. Definitive management combines microbiologic diagnosis, appropriately targeted antibiotics, and surgical source control when pus, dead bone, unstable tissue, or infected implants are present.
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