Osteomyelitis Treatment in Delhi, India

Osteomyelitis is a rare but severe condition characterised by bone infection. It generally occurs when a pre-existing infection in one part of the body travels via the bloodstream to the bone. This can also happen in open fractures. If this condition is left untreated, then the inflammation from this infection may result in the discontinuation of blood supply to the bone, eventually causing it to die.

The onset of osteomyelitis can be sudden, slow, mild, or even chronic, depending on the source of infection. Earlier, it was considered an untreatable condition, but with the advanced technology and latest approaches available in the medical field, it can be successfully treated.

Types of Osteomyelitis

These are as follows:

• Acute: Sudden onset. It is characterised by initial episodes of fever followed by pain in the affected region after a few days.
• Chronic: It usually doesn't respond well to treatments, and the person experiences recurrent drainage of pus. This kind of infection goes unnoticed for several months to years because no symptoms are present in an individual.
• Vertebral: This type of infection targets the spine, resulting in severe back pain that worsens with movement. It rarely presents with fever, and even rest and medications don't help.

Symptoms of Osteomyelitis

The symptoms of this condition vary depending on the type of infection present and the causes. The following are the most commonly seen symptoms of osteomyelitis:

• Fever
• Pain in the lower back
• Nausea
• Vomiting
• Loss of appetite
• Drainage of pus
• Restricted movement
• Sweating
• Swelling around the infected bone
• Tenderness around the infected region
• Irritability
• Skin discolouration
• Limp while walking

Causes of Osteomyelitis

• Hematogenous: This involves a pre-existing infection travelling to the bone through the bloodstream. It might occur due to Staphylococcus aureus, which enters the body through the IV route and is seen more commonly in children.
• Non-hematogenous: It may result from trauma like a fracture or an open wound. Surgery is also accountable for this type, primarily if it consists of a prosthetic material like screws, plates, and pins which carry bacteria or fungi.

Diagnosis of Osteomyelitis

A combination of specific tests and procedures is required to diagnose the presence of osteomyelitis and detect which germ is causing the infection. These include: 

• Blood test: CBC levels ascertain the signs of inflammation and infection. Blood culture also detects the presence of bacteria in the bloodstream.
• Imaging tests: These include

• X-Ray: It depicts the amount of bone damage in the scan. However, the extent of the damage is more visible if the condition is present for several weeks. However, in the case of recent episodes, more detailed imaging tests are required.
• Magnetic Resonance Imaging (MRI): It generates detailed images of bones and surrounding soft tissues.
• Computerised Tomography: This is usually carried out if someone is unable to undergo MRI. It generates detailed cross-sectional views of a person's internal structures.

• Bone Biopsy: It is performed to detect the pathogen responsible for bone infection. Identifying the germ is very helpful, as it makes it easier for doctors to treat the condition.

Treatment of Osteomyelitis

Treatment of osteomyelitis depends on a variety of factors, which are as follows:

• Age and overall health of the patient
• Extent of infection
• Drug tolerance for certain drugs

Treatment comprises of:

• Antibiotics destroy the infection-causing bacteria and are given for four to eight weeks. Initially, they are administered through IV for a week or two. Afterwards, they are given orally by mouth for several weeks. Finally, in case of chronic infections, antibiotics are given for a few months.
• Analgesics: NSAIDs are prescribed to relieve pain as well as inflammation.
• Antifungal drugs:  Oral antifungal medications are prescribed to treat fungal infections
• Needle Aspiration is performed to drain fluid and pus from the abscess.
• Surgery: These are as follows:

• Debridement: In this procedure, the surgeon removes the diseased and a small portion of healthy bone to ensure all the infected areas have been cleared. Along with the bone, the surrounding soft tissues can be removed.
• Spine surgery: It is carried out for people with vertebral osteomyelitis and prevents the spine from becoming damaged.

Risks of Osteomyelitis

A person is said to be at risk for developing osteomyelitis if they have the following factors:

• Recent fracture
• Diabetes
• Infection of blood, especially sickle cell anaemia
• Foot ulcer
• Any traumatic injury
• Metallic implants in the body, such as screws or pins
• Low immunity
• Artificial joints like Hip replacement
• Peripheral artery disease
• Patient on dialysis machine tubing

Complications of Osteomyelitis

These include:

• Osteonecrosis: This takes place when inflammation resulting from infection hampers blood supply to the bone. At times, it may lead to amputation.
• Septic arthritis: This takes place when an infection reaches the adjacent joint.
• Stunted growth: In children, the average growth in bones or joints is altered if osteomyelitis occurs at the end of long bones of arms or legs.
• Skin cancer: If osteomyelitis has resulted in an open wound draining pus, then surrounding areas of the skin are at a higher risk of developing squamous cell cancer.

Prevention of Osteomyelitis

Hygiene is the first step towards the prevention of this condition. Therefore, in case of any cut or open wound, it is advised to wash the wound entirely and do the dressing afterwards with the help of sterile bandages.

In the case of diabetes, the emphasis is being laid on foot care

In case of fractures, visit the surgeon 

Outlook

Most people with this condition respond to treatment and recover remarkably well. However, the prognosis is better if the infection is detected early and treatment starts immediately. Untreated or chronic infections may permanently damage bones, muscles and tissues.

Review

Reviewed by Dr. Vinay Aggarwal, Senior Consultant - Orthopaedics & Joint Replacement, Arthroscopy & Sports Injury 27 May 2024.