OSTEOMYLITIS

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTODUCTION-

Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs.

Smokers and people with chronic health conditions, such as diabetes or kidney failure, are more at risk of developing osteomyelitis. People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Although once considered incurable, osteomyelitis can now be successfully treated. Most people need surgery to remove areas of the bone that have died. After surgery, strong intravenous antibiotics are typically needed.

Osteomyelitis can affect both adults and children. The bacteria or fungus that can cause osteomyelitis, however, differs among age groups. In adults, osteomyelitis often affects the vertebrae and the pelvis. In children, osteomyelitis usually affects the adjacent ends of long bones. Long bones (bones in the arms or legs) are large, dense bones that provide strength, structure and mobility. They include the femur and tibia in the legs and the humerus and radius in the arms.

Osteomyelitis is not more common in a particular race or gender. However, some people are more at risk for developing the disease, including:

• People with diabetes.
• Patients receiving hemodialysis.
• People with weakened immune systems.
• People with sickle cell disease.
• Intravenous drug abusers.
• The elderly.

CAUSES-

It can be caused by a variety of microbial agents (most common in staphylococcus aureus) and situations, including:

• An open injury to the bone, such as an open fracture with the bone ends coming out through the skin.
• A minor trauma, which can lead to a blood clot around the bone and then a secondary infection from seeding of bacteria.
• Bacteria in the bloodstream (bacteremia), which is deposited in a focal (localized) area of the bone. This bacterial site in the bone then grows, resulting in destruction of the bone. However, new bone often forms around the site.
• A chronic open wound or soft tissue infection can eventually extend down to the bone surface, leading to a direct bone infection.

Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals.

Germs can enter a bone in a variety of ways, including:

• The bloodstream. Germs in other parts of your body — for example, in the lungs from pneumonia or in the bladder from a urinary tract infection — can travel through your bloodstream to a weakened spot in a bone.
• Injuries. Severe puncture wounds can carry germs deep inside your body. If such an injury becomes infected, the germs can spread into a nearby bone. Germs can also enter the body if you have broken a bone so severely that part of it is sticking out through your skin.
• Surgery. Direct contamination with germs can occur during surgeries to replace joints or repair fractures.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Risk factors

Your bones are normally resistant to infection, but this protection lessens as you get older. Other factors that can make your bones more vulnerable to osteomyelitis may include:

Recent injury or orthopedic surgery

A severe bone fracture or a deep puncture wound gives bacteria a route to enter your bone or nearby tissue. A deep puncture wound, such as an animal bite or a nail piercing through a shoe, can also provide a pathway for infection.

Surgery to repair broken bones or replace worn joints also can accidentally open a path for germs to enter a bone. Implanted orthopedic hardware is a risk factor for infection.

Circulation disorders

When blood vessels are damaged or blocked, your body has trouble distributing the infection-fighting cells needed to keep a small infection from growing larger. What begins as a small cut can progress to a deep ulcer that may expose deep tissue and bone to infection.

Diseases that impair blood circulation include:

• Poorly controlled diabetes
• Peripheral artery disease, often related to smoking
• Sickle cell disease

Problems requiring intravenous lines or catheters

There are a number of conditions that require the use of medical tubing to connect the outside world with your internal organs. However, this tubing can also serve as a way for germs to get into your body, increasing your risk of an infection in general, which can lead to osteomyelitis.

Examples of when this type of tubing might be used include:

• Dialysis machine tubing
• Urinary catheters
• Long-term intravenous tubing, sometimes called central lines

Conditions that impair the immune system

If your immune system is affected by a medical condition or medication, you have a greater risk of osteomyelitis. Factors that may suppress your immune system include:

• Cancer treatment
• Poorly controlled diabetes
• Needing to take corticosteroids or drugs called tumor necrosis factor inhibitors

Illicit drugs

People who inject illegal drugs are more likely to develop osteomyelitis because they may use nonsterile needles and are less likely to sterilize their skin before injections.

Complications

Osteomyelitis complications may include:

• Bone death (osteonecrosis). An infection in your bone can impede blood circulation within the bone, leading to bone death. Areas where bone has died need to be surgically removed for antibiotics to be effective.
• Septic arthritis. Sometimes, infection within bones can spread into a nearby joint.
• Impaired growth. Normal growth in bones or joints in children may be affected if osteomyelitis occurs in the softer areas, called growth plates, at either end of the long bones of the arms and legs.
• Skin cancer. If your osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer.

SYMPTOM-

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

The symptoms of osteomyelitis can include:

• Pain and/or tenderness in the infected area.
• Swelling, redness and warmth in the infected area.
• Fever.
• Nausea, secondarily from being ill with infection.
• General discomfort, uneasiness, or ill feeling.
• Drainage of pus (thick yellow fluid) through the skin.

Additional symptoms that may be associated with this disease include:

• Excessive sweating.
• Chills.
• Lower back pain (if the spine is involved).
• Swelling of the ankles, feet, and legs.
• Loss or decrease of motion of a joint.
• Changes in gait (walking pattern that is a painful, yielding a limp) or unwillingness to bear weight in children.

TREATMENT-

Treatment focuses on stopping infection in its tracks and preserving as much function as possible. Most people with osteomyelitis are treated with antibiotics, surgery, or both.

Antibiotics help bring the infection under control and often make it possible to avoid surgery. People with osteomyelitis usually get antibiotics for several weeks through an IV, and then switch to a pill.

More serious or chronic osteomyelitis requires surgery to remove the infected tissue and bone. Osteomyelitis surgery prevents the infection from spreading further or getting so bad that amputation is the only remaining option.

physical therapy approach-

Physical  therapists can play a vital role in the screening process for osteomyelitis.  Individuals who present with signs and symptoms of infection, possibly causing osteomyelitis, should be referred to a physician for further diagnostic testing.  These signs and symptoms are included in the above section. Prevention is another area in cases of osteomyelitis where physical therapists can play an important role.  Chronic osteomyelitis is often a result of complication of treatment with open fractures, therefore, prevention of infection is highly important^[3].  Since the role of nutrition is vital in cases of infection, patient need to be properly educated on proper nutrition in early post-surgical intervention due to the fact that most infections occur in the immediate post-operative period^[3].  Individuals who are at risk for developing osteomyelitis should also be taught proper preventative measures and be aware of early warning signs that infection may be present such as, excessive pus present coming from incision line, redness, extreme tenderness, increased skin temperature near area of injury or surgical procedure, and symptoms of nausea or vomiting. If treated surgically for osteomyelitis, physical therapy may be indicated post-operatively to address any impairments in strength, ROM, proprioception, etc. as well as treatment for any functional limitations or disability secondary to infection.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com