Osteomyelitis – Diagnosis and Treatment
Diagnosis
Laboratory Blood Work
Doctors often start by ordering blood tests when they suspect osteomyelitis. These tests cannot confirm the diagnosis alone, but they give clues about inflammation or infection.
Markers such as:
- White blood cell count (WBC)
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
CRP and ESR usually rise with infection or inflammation. Doctors may also order a blood culture to help identify bacteria in the bloodstream linked to bone infection.
Sometimes, blood tests reveal the bacteria causing the infection. Blood work guides doctors on whether to order more specific tests.
Imaging Technology
Doctors use imaging tests to examine bones and surrounding tissues more closely. Different scans help diagnose bone infections:
| Imaging Test | What It Shows | Notes |
|---|---|---|
| X-ray | Bone damage, visible after weeks | May miss early osteomyelitis |
| Magnetic Resonance Imaging (MRI) | Detailed images of bones and soft tissues | Detects early changes; very sensitive |
| Computed Tomography (CT) Scan | Bone and tissue structure from many angles | Used if MRI is not possible |
| Bone Scan | Infection areas using radioactive tracers | Highlights infected tissue |
| Ultrasound | Soft tissue changes near bone | Sometimes used, especially in children |
MRI scans show inflammation in long bones, the spine, or other affected areas. If MRI is not an option, doctors may use CT scans. Bone scans with tracers can detect infection early, even if x-rays look normal.
Collecting a Bone Sample
A bone biopsy gives the most accurate answer about osteomyelitis and the germ causing it. Doctors can take a bone sample in two main ways:
- Needle Biopsy: A doctor inserts a thin needle into the bone, using a scan to guide it. Local anesthesia numbs the area.
- Surgical (Open) Biopsy: A surgeon reaches the bone through a small cut while the patient is asleep. This method may be used if the spot is hard to reach or if more tissue is needed.
Both tests show which bacteria are in the bone. This helps doctors choose the right antibiotic or treatment plan.
Bone biopsies are important for long-term bone infections or for complex cases involving the spine or artificial joints.
Summary Table: Diagnostic Steps
| Step | Purpose |
|---|---|
| Initial blood tests | Check for infection or inflammation. |
| Imaging (MRI, CT, x-ray, others) | See bone and soft tissue changes. |
| Bone biopsy | Confirm diagnosis and germ type. |
Doctors look for signs like pain, swelling, or a wound near the bone to decide when to test for osteomyelitis.
Treatment
Surgical Approaches
Treatment often begins with surgery to remove infected or dead bone. Surgeons choose the right option based on the infectionโs severity and type.
| Surgical Procedure | Purpose |
|---|---|
| Drainage | Removes pus and infection fluid. |
| Debridement | Excises infected tissue and some healthy tissue. |
| Bone or Tissue Grafting | Helps repair bone and restore circulation. |
| Foreign Object Removal | Eliminates sources of ongoing infection. |
- Drainage of Infection: Surgeons open the area around the infected bone to remove pus or fluid buildup. This step reduces swelling and clears out harmful bacteria such as Staphylococcus aureus.
- Debridement Process: The surgeon cuts away all infected or dead bone and may remove some nearby healthy tissue. This helps stop the infection from spreading and prevents complications.
- Bone Repair and Blood Flow Restoration: If removing bone leaves empty spaces, surgeons may fill them with bone grafts or tissue from another part of the body. Grafts support new bone and blood vessel growth, which is needed for recovery.
- Taking Out Foreign Materials: Surgeons may remove devices like plates or screws if they are contaminated to prevent the infection from returning.
Medication Solutions
Doctors select antibiotics based on lab results that show which germ is causing the infection. They often start with intravenous antibiotics for about six weeks.
If needed, patients may switch to oral antibiotics for longer care at home. Managing other health conditions, such as diabetes, is also important during treatment.
Healthy habits like not smoking can help healing and support treatment choices. Doctors may also prescribe medicines for pain while the infection heals.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Preparation helps you get the most from your appointment. Write down all current symptoms and when each one started.
Common symptoms include pain, swelling, redness, or fever. Mention if you have diabetes or changes in your immune system.
Bring a list of all medicines, vitamins, or supplements you take, including amounts and how often you take them. This helps your healthcare provider avoid medicine problems.
Write down questions you want to ask, such as:
- What could be causing these symptoms?
- What tests might be needed?
- Which treatments are available?
- Will surgery be necessary?
- How do you manage this condition with other health problems?
A simple table can help organize your information:
| Symptom | When it Started | Severity |
|---|---|---|
| Pain | Last week | Moderate |
| Swelling | 2 days ago | Mild |
| Fever | Today | High |
What Your Provider Might Ask or Do
During your visit, the healthcare provider will likely ask about:
- Recent fever, chills, or other signs of infection.
- Any new or worsening pain and what triggers it.
They may ask about recent injuries, cuts, or surgeries. The provider might ask if you have a history of diabetes or foot ulcers, since these can increase your risk for bone infections.
They may ask about any changes in your immune system, especially if you take medicines that affect it. Your provider may review your medicine list. They may also discuss any ongoing health conditions.
