Osteomyelitis

Osteomyelitis is infection and destruction of bone caused by aerobic or anaerobic bacteria, mycobacteria and fungi. It favors the vertebrae, the foot in diabetics, and penetrating bone injury from trauma or surgery; in children the commonest site is a well-vascularized long bone such as the tibial or femoral metaphysis. Osteomyelitis is acute or chronic by progression; the transition is gradual, not a matter of time. After acute inflammation subsides, the presence of sequestrum, sinus or dead space means chronic osteomyelitis. Acute osteomyelitis includes acute pyogenic, subacute, acute iliosacral and acute vertebral osteomyelitis; chronic osteomyelitis includes chronic pyogenic, localized, sclerosing and tuberculous osteomyelitis.

Common Symptoms

Bacterial infection; depressed brow; bone destruction; bone pain; bone marrow edema; child unable to lie flat; sequestrum; cardiac stabbing pain; soft tissue swelling

Causes

Over 95% of urinary tract infections are caused by a single bacterium; 90% of outpatients and about 50% of inpatients have Escherichia coli, with up to 140 serotypes; uropathogenic E. coli is the same type as that isolated from patient feces, common in asymptomatic bacteriuria or uncomplicated infection; Proteus, Aerobacter, Klebsiella pneumoniae, Pseudomonas aeruginosa and fecal streptococci are seen in reinfection, catheterized and complicated infections; Candida albicans and Cryptococcus neoformans in diabetics, users of glucocorticoids and immunosuppressants, and after renal transplant; Staphylococcus aureus in skin trauma and bacteremia or sepsis in drug users; viral and mycoplasma infection is rare but increasing. Theories include neurovascular dysregulation, blood hypercoagulability and adrenal hyperfunction; in recent decades immune factors have been emphasized, and many consider it an autoimmune disease based on humoral, cellular and immunopathological observations. Obesity from overeating and reduced physical activity is the main environmental factor for type 2 diabetes, predisposing genetically susceptible individuals; type 1 diabetes involves immune abnormalities where infection by certain viruses such as coxsackie, rubella and mumps triggers autoimmunity that destroys pancreatic beta cells.

Treatment

Medication, supportive treatment, surgery

Prevention

I. Prevent common infections: boils, furuncles, carbuncles and upper respiratory infection are common and easily complicate into hematogenous osteomyelitis, so preventing them is important: 1. Keep indoor air flowing, maintain hygiene and clean skin. 2. In adolescence eat more vegetables and fruit, use less skin oil to prevent sebaceous blockage. 3. Strengthen exercise to prevent colds. 4. Treat recurrent tonsillitis actively, considering tonsillectomy if needed. II. Prevent traumatic infection: it is a common cause; strengthen labor safety, prevent abrasions and accidents; after trauma seek care immediately, do not let unqualified practitioners massage or squeeze, and keep abrasions clean; properly treat soft-tissue injury and fractures and treat infection promptly. III. Detect and treat infection early: severity relates to systemic and local conditions and to early detection; superficial infection is obvious, while deep infection is hard to diagnose, with marked swelling despite little local inflammation, so examine and analyze carefully. IV. Manage open fractures: first prevent infection; internal fixation is generally not favored because foreign pins may continue to irritate injured tissue and cause secondary infection; we usually use hemostasis, debridement, reduction, topical hemostatic drugs and small splints; if an internally fixed open fracture becomes infected and spreads to the medullary cavity, inflammation spreads along the nail, so remove the internal fixation first to control infection.

Recommended Department

It is recommended to visit the orthopedic surgery department; before the visit you may first book an appointment and connect with experts through this platform.

Warm reminder: The above information is provided for health education reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek care at a regular hospital in time.