Osteomyelitis

Osteomyelitis is an infection that affects the bones. Bacteria are usually responsible in most cases, but it can also be caused by fungi or other germs. This condition can affect any bone in the body, but it tends to prefer long bones in children and vertebrae, hips, and bones in the feet in adults. When the bone becomes infected, the bone marrow inside becomes inflamed, which puts pressure on the blood vessels, limiting blood flow to the bone structure. As a result, the risk of part of the bone dying increases.

Acute osteomyelitis is referred to when it manifests suddenly (the evolution period does not exceed two weeks), and chronic osteomyelitis when the infection persists. Although a universal classification system has not been established, it is common to rely on the disease's etiology (Waldvogel classification) or on the anatomy of the affected bone (Cierry-Mader classification) to categorize it:

Waldvogel Classification:

• Hematogenous Osteomyelitis: The infection reaches the bone through the bloodstream. It is more common in children, who typically develop it in long bones, while adults can also present it in the vertebrae.
• Osteomyelitis Secondary to a Focus or Direct Inoculation: The infectious agents reach the bone through an open wound or after surgery.
• Osteomyelitis Associated with Vascular Insufficiency and Neuropathy: It develops in people with other conditions, such as diabetes or vascular insufficiency. It is common in foot bones.

Cierry-Mader Classification:

• Medullary Osteomyelitis: The infection is limited to the medullary canal, especially the endosteum, which is the membrane that surrounds the interior of the bone tissue.
• Superficial Osteomyelitis: It remains in the cortical bone, the hard outer part of the bone.
• Localized Osteomyelitis: The infectious agents invade both the cortical and medullary areas. The bone remains stable.
• Diffuse Osteomyelitis: It affects all parts of the bone, making it potentially unstable.

Osteomyelitis can affect anyone, but it is more common in children and the elderly. When detected and treated on time, it can be cured without complications.

Symptoms

Although they can vary depending on the patient’s age and the bone affected, the most characteristic symptoms of osteomyelitis are:

• Pain
• Swelling
• Redness of the affected area
• Fever
• Fatigue and general discomfort

Some people, especially older individuals, may remain asymptomatic.

Causes

Osteomyelitis is typically caused by staphylococci (Staphylococcus), with the most frequently isolated bacterium in osteomyelitis of any origin and age group being S. aureus. However, other bacteria such as Pseudomonas aeruginosa, Serratia marcescens, or Escherichia coli can sometimes be involved. These bacteria can reach the bone:

• Through the bloodstream from other infected parts of the body.
• Through infection of open wounds, which can be caused by puncture injuries that penetrate the body or bone fractures.
• Through contamination during surgery.

Risk Factors

The factors that increase the risk of developing osteomyelitis are:

• Age: It is more frequent among children and the elderly.
• Diseases affecting the immune system, such as diabetes or cancer.
• Circulatory disorders, such as peripheral arterial disease.
• Treatments administered via catheters, such as dialysis.
• Recent injuries.
• Previous orthopedic surgery.

Complications

The most common complications of osteomyelitis are:

• Osteonecrosis or bone death: Insufficient blood reaches the bone.
• Septic arthritis: The infection spreads to nearby joints.
• Bone deformities or fractures.
• Growth abnormalities: When osteomyelitis occurs in young children, the degree of development may not meet expected growth.
• Septic embolism: Infected blood clots form in the bloodstream and travel to the lungs.
• Bacterial endocarditis: Bacteria reach the heart and infect the endocardium (the layer that covers the inside of the chambers and valves).

Prevention

Preventing osteomyelitis is difficult. However, it is important to avoid injuries, scratches, insect bites, or animal bites to minimize the risk of infectious agents entering the bloodstream. If these occur, it is crucial to keep the wounds clean.

Which doctor treats osteomyelitis?

The diagnosis and treatment of osteomyelitis are carried out by a specialist in orthopedic surgery and traumatology. However, sports medicine specialists can also detect it, as some types are associated with physical exercise.